Aortic Intimal Staining In Fresh Water Drowning – A Case Series

Case Series

Austin J Forensic Sci Criminol. 2015;2(2): 1017.

Aortic Intimal Staining In Fresh Water Drowning – A Case Series

Jayanth S Hosahally*, Girish Chandra YP and A Gokulakrishnan

Department of Forensic Medicine, M.S. Ramaiah Medical College, India

*Corresponding author: Jayanth S Hosahally, Department of Forensic Medicine, M.S. Ramaiah Medical College, India

Received: February 04, 2015; Accepted: March 20, 2015; Published: March 30, 2015


There is usually a suspicion on the cause of death whenever a body is recovered from water. There are no pathognomonic findings to indicate the diagnosis of drowning at autopsy. The diagnosis is based on the circumstances of the death and various nonspecific anatomical findings. It is one of the most difficult modes of death to prove at postmortem. Fresh water drowning brings about hemodilution and hemolysis; which in turn stains the intima of the aortic root. The present study was undertaken to know the importance of this phenomenon in fresh water drowning. A total of ten cases were studied and the study group was divided into group A and group B. Group A consists of five drowning cases and Group B consists of five control cases other than drowning with similar post mortem interval. Aortic intimal staining was demonstrated in all cases of drowning.

Keywords: Drowning; Autopsy; Fresh water; Aortic root; Intimal staining


Drowning is a difficult autopsy diagnosis due to various reasons. Most of the significant autopsy findings start to fade after body is recovered from water. In addition to drowning, injuries, intoxications or natural conditions are all among the potential causes of death in bodies found in water or the factor that may have contributed to the fatal outcome [1]. It has been suggested in the literature, that hemodilution caused by drowning causes red cell lysis which further stains the intima of the aorta. However, this has been based predominantly on anecdotal autopsy observations, and recent texts have not tended to mention this phenomenon resulting in uncertainty as to its significance [2]. Differential hemolytic staining of the intima of the pulmonary artery and aortic root may be useful at autopsies on bodies recovered from water. German literature has recognized this feature for many years as ‘hemoglobin imbibitions’ of the intima due to ‘hypo-osmolar hemeolysis’ and is used as an indicator of freshwater drowning [3]. This observation may have considerable diagnostic significance. This study was taken up to evaluate this in fresh water drowning cases.

Material and Methods

This study was conducted at the Department of Forensic Medicine, M.S. Ramaiah Medical College Bangalore, in 2013, wherein 5 fresh water drowning cases and 5 control cases were evaluated. Pulmonary trunk and aorta were dissected and looked into as part of standard autopsy examinations.

Case 1 and 2 (Figure 1 & 1a) with post mortem interval of 8-10 hr showed staining of aortic intima with lack of pulmonary root staining. Cases 3 (Figure 2 & 2a) and 4 with post mortem interval of 12- 14 hr and 14 – 16 hr respectively showed increased intensity of intimal staining in the aortic root compared to cases 1 and 2. Case 5 with a post mortem interval of 24 to 28 hr showed staining of both aortic intima and pulmonary root. In this case decomposition had set in and pulmonary root is stained with less intensity than aortic root, in addition to flabbiness and reddish brown discoloration of heart.