Forensic Pathology, University Center of Legal Medicine, Geneva University Hospitals and University of Geneva, rue Michel-Servet 1, CH-1211, Geneva 4, Switzerland.
Acute Medicine Department, Hyperbaric Medicine Unit, Geneva University Hospitals, rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
Int J Legal Med. 2022 May;136(3):713-717. doi: 10.1007/s00414-022-02809-x. Epub 2022 Mar 14.
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.
浸没性肺水肿是一种罕见的、认识不足的、潜在致命的病理学，发生在水肺潜水和其他浸没相关活动（游泳或无呼吸潜水）期间。病理生理学非常复杂，尚未完全理解，但它的机制涉及到浸没期间跨毛细血管压力升高引起的肺泡毛细血管屏障的改变，导致液体和血液在肺泡空间积聚。诊断仍然是临床医生和法医从业者的一个挑战。症状在上升过程中开始出现，表现为咳嗽、泡沫痰和咯血。听诊可闻及肺水肿的体征。胸部 CT 扫描是首选的影像学检查，显示磨玻璃样混浊和小叶间隔增厚，最终表现出一种模式分布，可能在前两肺的节段。除了支持生命功能外，没有特定的治疗方法，高压氧治疗也不被系统推荐。我们报告了一起在休闲潜水员中发生的致命性 IPE 病例，该潜水员不幸在最后一次潜水后不久死亡。诊断是在包括死后计算机断层扫描、全面法医尸检、组织学检查和毒理学分析在内的完整法医调查后做出的。
