Type:
Educational Exhibit
Keywords:
Foreign bodies, CT, Conventional radiography, Thorax
Authors:
R. Scandiffio1, C. Giaconi1, M. Barattini2, P. Vagli1, P. Bemi1, A. Mantarro1, C. Bartolozzi1; 1Pisa/IT, 2Carrara (MS)/IT
DOI:
10.1594/ecr2011/C-1566
Imaging findings OR Procedure details
Near- drowning is an emergency: an accurate,
rapid assessment is fundamental,
and chest X- ray is supportive in distinguish patients with or without evidence of aspiration and allows to evaluate therapy response and possible complications.
CT can be helpful in near- drowning associated to trauma,
especially in suspicion of spinal chord injury,
and in unexpected deterioration of victim condition.
Stage 1 is characterized by perihilar alveolar consolidations,
Kerley lines and peribronchial thickening; these findings are transient and usually disappear in 24- 48 hours.
Apices,
bases and lateral lung fields tend to be spared.
Radiological findings in stage 2 and 3 are quite similar and aspecific; airspace consolidations can involve an entire lobe or present as small,
ill- defined opacities.
No changes in heart diameter are observed.
Sand aspiration can lead to sand bronchogram,
with radiodense material in tracheobronchial tree [7].
Resolution depends on alveolar and endothelium damage,
but is usually slow and can be complicated by ARDS and superinfections [3,
5,
6].
ARDS and pneumonia present aspecific radiological findings in near- drowning; aerobic gram- negative bacteria are prevalent causes of pneumonia associated with near-drowning and usually manifest as lobar pneumonia.
ARDS is the most severe form of permeability edema associated with diffuse alveolar damage (DAD).
Three stages are recognized in ARDS.
Exudative stage is characterized by interstitial edema that rapidly evolves into alveolar consolidation in peripheral- cortical distribution with air bronchogram.
ARDS tipically presents a gravitational gradient.
In proliferative stage (stage 2),
ground- glass areas appear,
followed by fibrosis and subpleural and intrapulmonary cysts ( fibrotic stage).