Near-drowning pulmonary edema

Case contributed by Adrià Roset Altadill
Diagnosis almost certain

Presentation

Suffered from a panic attack while scuba diving and swallowed large amounts of salt water while getting out of the sea.

Patient Data

Age: 65 years
Gender: Female
x-ray

Bilateral perihilar airspace opacities with Kerley B lines more evident on the right lung.

Bilateral central areas of ground glass with associated patchy consolidation in the lower lobes. Smooth interlobular septal thickening in both apexes and lower lobes.

No pleural effusions or cardiomegaly.

No evidence of pulmonary embolism.

Case Discussion

Chest X-ray findings suggested pulmonary edema. However, a CT pulmonary angiogram was performed to rule out pulmonary embolism due to a raised D-dimer of 3081 ng/mL. CT findings confirmed non-cardiogenic pulmonary edema, and given the patient’s presentation, a final diagnosis of near-drowning pulmonary edema was achieved.

The patient’s clinical status dramatically improved in the next 24 hours without needing supplementary oxygen. Antibiotics were administered to cover potential superimposed infection due to aspiration. The patient was finally discharged asymptomatically one day later.

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