Achados necroscópicos no afogamento e diagnóstico diferencial entre morte por afogamento, lesões perimortem e ação de fauna aquática

Abstract

Introduction: Fatal drowning remains an integrative medicolegal diagnosis. No autopsy, histological, radiological, or laboratory finding is independently pathognomonic, and aquatic decomposition may erase signs of aspiration or create artifacts that mimic trauma. Objective: To synthesize the main autopsy findings and ancillary examinations in drowning, discuss their limitations, and propose criteria for differentiating fatal drowning, postmortem immersion, perimortem injuries, and changes produced by the aquatic environment. Methods: An integrative review guided by the Population or Problem, Concept, and Context framework. Studies published between January 2021 and May 2026 were prioritized and complemented by classic reviews, autopsy guidelines, and earlier studies essential to the interpretation of diatoms, postmortem imaging, and aquatic taphonomy. Results: Foam at the mouth and nostrils, froth in the airways, pulmonary hyperinflation, edema, Paltauf spots, and fluid in the digestive tract may support the diagnosis, but their frequency and specificity vary. Diatom analysis is an ancillary test subject to false-positive and false-negative results and laboratory contamination. Postmortem computed tomography documents fluid in the paranasal sinuses, mastoid air cells, and airways, as well as pulmonary changes, but does not conclusively distinguish drowning from postmortem immersion. Fish and crustaceans may remove tissue and cause irregular defects without vital reaction. Conclusion: Diagnosis should combine circumstances, external examination, complete autopsy, histology, toxicology, selected ancillary examinations, and taphonomic assessment. In decomposed bodies, the conclusion should explicitly state its limitations and use probabilistic language without assigning absolute value to any single sign or test.