Fatal diving: could it be an immersion pulmonary edema? Case report

Abstract

Immersion pulmonary edema is a rare, underrecognized, and potentially lethal pathology developing during scuba diving and other immersion-related activities (swimming or apnoea). Physiopathology is complex and not fully understood, but its mechanisms involve an alteration of the alveolo-capillary barrier caused by transcapillary pressure elevation during immersion, leading to an accumulation of fluid and blood in the alveolar space. Diagnosis remains a challenge for clinicians and forensic practionner. The symptoms begin during ascent, with cough, frothy sputum, and hemoptysis. Auscultation reveals signs of pulmonary edema. Pulmonary CT scan, which is the radiological exam of choice, shows ground glass opacities and interlobular thickening, eventually demonstrating a patterned distribution, likely in the anterior segments of both lungs. Apart from the support of vital functions, there is no specific treatment and hyperbaric oxygen therapy is not systematically recommended. We present a case of fatal IPE occurring in a recreational diver who unfortunately died shortly after his last dive. Diagnosis was made after complete forensic investigations including post-mortem-computed tomography, complete forensic autopsy, histological examination, and toxicological analysis.

„Negativdruck-Lungenödem“ und „alveoläre Hämorrhagie“ als Komplikationen einer oberen Atemwegsobstruktion

“…Ebenso kann es bei Personen in großer Höhe bzw. Meerestiefe oder bei Patienten mit hochgradiger Mitralstenose zu Schädigungen der Kapillarwand mit Lungenödem und alveolärer Hämorrhagie kommen [23][24][25]. Häufig reißen Kapillarendothel und Alveolarepithel und die Basalmembran bleibt intakt.…”

Myocardial oedema in the setting of immersion pulmonary oedema - Cause or effect?

“…Diuresis, bronchodilators and continuous positive airway pressure may be necessary in some instances, while invasive mechanical ventilation with haemodynamic support is reserved for the most severe cases. Episodes typically resolve within 24–48 hours of leaving the water, but autopsy findings have been suggestive of IPE in approximately 10% of scuba-diving deaths 13 14. Notably, left ventricular hypertrophy was confirmed in all such cases.…”