DIAGNOSIS OF DROWNING BY COMBINED COMPUTER-ASSISTED HISTOMORPHOMETRY OF LUNGS WITH BLOOD STRONTIUM DETERMINATION

The aim of our study was to examine the combined contribution of compu ter-assisted histomorphometry of lungs with blood strontium (BS) measu rement to the diagnosis of drowning in cadavers recovered from fresh w ater. The study population comprised 116 drowned subjects. The results for this group were compared with those obtained for three non-drowne d groups: 22 subjects who died from causes other than asphyxia, 13 sub jects who died of asphyxia (strangulation or hanging); and 23 healthy living subjects in whom normal BS level was measured. Samples of water where the bodies had been found were analyzed in order to establish a relation with the BS concentration of the drowned subjects. Histologi cally, each type of pulmonary lesion (congestion, edema, alveolar macr ophages, alveolar hemorrhage, and emphysema aquosum) was evaluated sem iquantitatively using a score according to the severity of the patholo gy. Then, a quantitative histomorphometric study was performed using a computer-assisted image analyzer to measure the length and thickness of the alveolar walls, and the area and density of the alveolar caviti es. The mean values of the BS levels in the 116 drowned subjects and o f the water strontium concentrations were found to be much higher than in the living individuals. Although the ranges were wide, we found no overlap between values found in drowned subjects and those in non-dro wned subjects. Emphysema aquosum and to a lesser extent alveolar hemor rhage were found to be the most significant histologic changes in the drowned and asphyxia groups compared with the nonasphyxia control grou ps.