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Question #155 (8/21/2026)

National Association of Medical Examiners 
Educational Activities Committee

Submitted by Dr. Hannah P. McQueen (PGY-3 AP/CP Resident Pathologist and Member of the NAME Educational Activities Committee), Will Boggs (Medical Student, MS-4), and Dr. Nicholas I. Batalis (Professor, Department of Pathology and Laboratory Medicine and Member), from the Medical University of South Carolina (MUSC), Charleston, South Carolina, United States.
1.A 48-year-old man dies shortly after presenting to the emergency department. The decedent was an experienced diver who had been SCUBA-diving and spearfishing with a friend at a depth of about 95 feet. During the dive, the friend lost sight of the decedent, and found his spear gun on the ocean floor. He ascended to discover the decedent thrashing around in distress, who then submerged before the boat could reach him. The decedent was located and pulled out of the water approximately 20 minutes later. He was unresponsive.

At autopsy, the decedent had conjunctival and mucosal petechiae, scattered facial abrasions and contusions, and crepitant skin of the chest and neck. Internal findings included multifocal subscalpular hemorrhages, hemorrhages of the sinuses and petrous ridges, and the findings demonstrated in the provided photos.

Which investigation would provide the greatest diagnostic value in establishing the cause and circumstances of death?