The significance of evaluating sphenoid sinus fluid by postmortem computed tomography in cases of drowning

Jin-Haeng Heo; Yongsu Yoon; In-Soo Seo; Sang-Beom Im; Young San Ko; Sookyoung Lee; Seon Jung Jang

doi:10.1016/j.jflm.2023.102551

The significance of evaluating sphenoid sinus fluid by postmortem computed tomography in cases of drowning

J Forensic Leg Med. 2023 Jul:97:102551. doi: 10.1016/j.jflm.2023.102551. Epub 2023 Jun 15.

Authors

Jin-Haeng Heo¹, Yongsu Yoon², In-Soo Seo³, Sang-Beom Im⁴, Young San Ko³, Sookyoung Lee⁵, Seon Jung Jang³

Affiliations

¹ Forensic Medicine Division, Busan Institute, National Forensic Service, Yangsan, Republic of Korea; Department of Multidisciplinary Radiological Science, The Graduate School of Dongseo University, Busan, Republic of Korea.
² Department of Multidisciplinary Radiological Science, The Graduate School of Dongseo University, Busan, Republic of Korea; Center for Radiological Environment & Health Science, Dongseo University, Busan, Republic of Korea. Electronic address: ysyoon@office.dongseo.ac.kr.
³ Forensic Medicine Division, Busan Institute, National Forensic Service, Yangsan, Republic of Korea.
⁴ Forensic Medicine Division, Gwangju Institute, National Forensic Service, Jangseong, Republic of Korea.
⁵ Division of Forensic Medical Examination, National Forensic Service, Wonju, Republic of Korea.

PMID: 37339573
DOI: 10.1016/j.jflm.2023.102551

Abstract

Purpose: In cases of drowning, the presence of sphenoid sinus fluid is a non-specific autopsy finding. However, studies have reported that fluid accumulation in the paranasal sinuses is more commonly observed in drowning victims. Furthermore, some laboratory tests, such as diatom and electrolyte analysis, can serve as supplementary diagnostic tools for diagnosing drowning. Therefore, accurate sphenoid sinus fluid sampling is an important aspect of an autopsy in suspected drowning cases. The aim of this study was to identify the significance of evaluating sphenoid sinus fluid by PMCT images in cases of drowning.

Methods: We retrospectively reviewed 54 drowning victims who underwent PMCT and forensic autopsy. Fluid volume in the sphenoid sinus was measured using a graduated syringe during autopsy and a three-dimensional (3D) workstation based on PMCT images was used for the purpose of comparison. The Mann-Whitney U test and Spearman's rank correlation coefficient was used to evaluate statistically significant differences and correlations. Additionally, a Bland-Altman plot was employed to assess the agreement between PMCT and autopsy.

Results: The median volume was 1.65 (range 0.00-12.4) ml and 1.55 (range 0.00-7.00) ml in the PMCT and autopsy, respectively, showing a statistically insignificant difference (p = 0.294) and a significant correlation (Rs = 0.896). In 35 cases, the PMCT overestimated the fluid volume more than the autopsy, whereas in 14 cases, the PMCT underestimated the fluid volume. No fluid was identified in seven cases during the autopsy, whereas in five patients, no fluid was found in both PMCT and autopsy. By analyzing the Bland-Altman plot, a bias of 0.73 ± 1.4 ml and limits of agreement ranging from -2.04 to 3.51 ml were observed for sphenoid sinus fluid volume measurements.

Conclusions: Based on the limitations of traditional fluid volume measurement in the sphenoid sinus during autopsy, we propose the utilization of PMCT volumetric analysis prior to autopsy as a means to enhance the detection of sphenoid sinus fluid in cases of drowning.

Keywords: Autopsy; Drowning; Fluid accumulations; Forensic medicine; Post-mortem computed tomography; Sphenoid sinus.

MeSH terms

Body Fluids* / chemistry
Body Fluids* / diagnostic imaging
Drowning* / diagnostic imaging
Drowning* / pathology
Humans
Middle Aged
Postmortem Changes*
Sphenoid Sinus* / diagnostic imaging
Sphenoid Sinus* / pathology
Tomography, X-Ray Computed