The Westchester grandmother who plunged into an open manhole in Midtown died of scald burns and a combination of other severe injuries, the city’s medical examiner ruled on Wednesday.

The shocking death of Donike Gocaj, 56, was officially ruled an accident, officials said.

Gocaj fell into an uncovered manhole after parking her SUV along East 52nd Street near Fifth Avenue around 11:20 p.m. on Monday.

She suffered inhalational thermal injuries and blunt force trauma to her torso, all of which contributed to her death, according to the medical examiner.

The horrific combination of injuries is consistent with a fall into superheated steam, which is often present in New York City manholes, said Barbara Butcher, former chief of staff at the city’s medical examiner’s office.

β€œPerhaps the most damaging injury was the inhalation of steam, which would have damaged the alveoli β€” the tiny air sacs in the lungs that transfer oxygen to the bloodstream,” Butcher explained. β€œWhen they swell, they can no longer bring in oxygen.

β€œThe steam would have caused scald burns on her skin, but the real cause of injury was the inhalation.”

Lee Ann Grossberg, a forensic pathologist in North Carolina, described such injuries as particularly dreadful.

β€œThat would have been a really painful death,” she said.

A witness recounted that Gocaj β€” a devoted mother and grandmother from Briarcliff Manor β€” hauntingly screamed β€œI’m dying” as bystanders desperately tried to help her before first responders arrived. The Con Edison utility hole she fell into was filled with boiling water and steam, the witness said.

The medical examiner’s ruling confirmed that Gocaj died from horrific heat-related injuries.