Distinction between saltwater drowning and freshwater drowning by assessment of sinus fluid on post-mortem computed tomography

Objective To evaluate the difference in sinus fluid volume and density between saltwater and freshwater drowning and diagnose saltwater drowning in distinction from freshwater drowning. Methods Ninety-three drowning cases (22 saltwater and 71 freshwater) were retrospectively investigated; all had undergone post-mortem CT and forensic autopsy. Sinus fluid volume and density were calculated using a 3D-DICOM workstation, and differences were evaluated. Diagnostic performance of these indicators for saltwater drowning was evaluated using a cut-off value calculated by receiver operating characteristic (ROC) analysis. Results The median sinus fluid volume was 5.68 mL in cases of saltwater drowning (range 0.08 to 37.55) and 5.46 mL in cases of freshwater drowning (0.02 to 27.68), and the average densities were 47.28 (14.26 to 75.98) HU and 32.56 (−14.38 to 77.43) HU, respectively. While sinus volume did not differ significantly ( p = 0.6000), sinus density was significantly higher in saltwater than freshwater drowning cases ( p = 0.0002). ROC analysis for diagnosis of saltwater drowning determined the cut-off value as 37.77 HU, with a sensitivity of 77 %, specificity of 72 %, PPV of 46 % and NPV of 91 %. Conclusion The average density of sinus fluid in cases of saltwater drowning was significantly higher than in freshwater drowning cases; there was no significant difference in the sinus fluid volume. Key points • Sinus fluid density of saltwater drowning is significantly higher than freshwater drowning . • Cut - off value was 37.77 HU based on the ROC analysis . • The cut - off value translated to 91 % NPV for diagnosis of saltwater drowning .