Shell fragment aspiration seen at post-mortem computed tomography indicating drowning

•Diagnosis of drowning is possible with CT.•Aspiration of waterborne foreign bodies is indicative of drowning.•Larger waterborne foreign bodies are visible in CT.

The diagnosis of death due to drowning may be difficult, especially in cases of advanced decomposition, as most findings indicative of drowning sought for during post-mortem imaging and autopsy become obscured.The detection of diatoms within the corpse may still allow for the diagnosis of drowning, even if all other findings have decomposed. Other particles found in natural bodies of water, especially near the shore, are shell fragments. These shell fragments do not decompose either and can therefore also be detected within a badly decomposed body.We here report the detection of such shell fragments by post-mortem computed tomography in the airways of a body showing signs of decomposition. The presence of fragments in even very peripheral bronchi indicated that large amounts of shell fragment-laden water were aspirated, thus leading to the conclusion that the man died due to drowning.