Near drowning (pulmonary oedema)

Case contributed by Dr Jan Frank Gerstenmaier

Presentation

This student was found intoxicated and submerged in a canal.

Patient Data

Age: 16
Gender: Male

Resescitation room chest radiograph

Modality: X-ray

The patient is intubated. There are bilateral airspace opacities with peripheral sparing. Heart and mediastinal contours appear normal.

One day post admission

Modality: CT

Patchy airspace opacification extending to pleural surfaces posteriorly and at the fissures with sparing of anterior zones. No pleural effusion.

Day 1 post admission; ICU chest radiograph

Modality: X-ray

There has been progression of airspace opacities The patient remains intubated and on ventilatory support.

Case Discussion

This type of non-cardiogenic pulmonary oedema is considered a result of inhalation of either fresh- or seawater. The radiographic signs are non-specific and resemble those of any other cause of pulmonary oedema.

This patient was weaned off ventilatory support and left ICU after 5 days. He did not suffer hypoxic-ischaemic brain injury.

This case aslo shows an inherited  radiological misnomer that is likely to continue into perpetuity: the imgae is labelled "portable" which is patently incorrect. The machine  that generated the image is mobile but not portable. You cannot pick it up but you can move it around the hospital.

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Case Information

rID: 24685
Case created: 5th Sep 2013
Last edited: 19th Sep 2016
System: Chest
Inclusion in quiz mode: Included

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