대한흉부영상의학회 Weekly Chest Cases

Courtesy of Min Kyung Kim, Soyeoun Lim, Woon-Jung Kwon / Ulsan University Hospital, University of Ulsan College of Medicine
Age/Sex 53 / M
Chief ComplaintDyspnea after ship cleaning

Diagnosis: Immersion pulmonary edema
Radiologic Findings: Fig 1. Chest PA shows diffuse consolidation in both lungs
Fig 2. CT scan shows extensive ill-defined ground glass opacities & consolidations in both lungs
Fig 3. On mediastinal window setting, there was no pleural effusion or cardiomegaly.
Brief Review: Immersion pulmonary edema (IPE) is an acute pulmonary edema that develops during scuba diving, snorkeling, breath-hold diving, or intense activities.
The pathophysiology of IPE is still incompletely understood. One of theories explains that during immersion in water, central redistribution of blood from the extremities occurs, and is augmented when the water is cold. The resulting engorgement of the central veins, heart and pulmonary vessels causes increased right sided intravascular pressures and increased pulmonary capillary pressure, and finally cause leakage of fluid and blood into the alveolar space.
Risk factors include age of more than 50 years, female sex, heart disease, excess pre-exercise fluid intake, use of tight wetsuits, and cold exposure.
Chest radiograph and CT show pulmonary edema without cardiomegaly.
Most patients with IPE show improvement within 72 h with rest and oxygen administration under atmospheric pressure.
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대한흉부영상의학회 Korean Society of Thoracic Radiology