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Fatal diving: could it be an immersion pulmonary edema? Case report
France Evain1, Pierre Louge2, Rodrigue Pignel2
1Forensic Pathology, University Center of Legal Medicine, Geneva University Hospitals and University of Geneva, rue Michel-Servet 1, CH-1211, Geneva 4, Switzerland. france.evain@hcuge.ch.
International Journal of Legal Medicine
|March 14, 2022
Summary
Immersion pulmonary edema (IPE) is a rare, fatal lung condition during diving. Diagnosis is challenging, often confirmed post-mortem through forensic investigation.
Area of Science:
- Cardiovascular and Respiratory System Physiology
- Diving Medicine and Pathology
- Forensic Medicine and Toxicology
Background:
- Immersion pulmonary edema (IPE) is a rare, potentially lethal condition associated with diving and other water immersion activities.
- Its complex pathophysiology involves increased transcapillary pressure altering the alveolo-capillary barrier, leading to alveolar fluid and blood accumulation.
- Accurate diagnosis is difficult for clinicians and forensic practitioners.
Observation:
- Symptoms include cough, frothy sputum, and hemoptysis during ascent, with auscultation revealing pulmonary edema signs.
- Pulmonary CT scans show characteristic ground-glass opacities and interlobular thickening, often in anterior lung segments.
- This case details a fatal IPE in a recreational diver, diagnosed via comprehensive forensic investigation.
Findings:
- IPE involves fluid and blood accumulation in the alveolar space due to altered alveolo-capillary barrier integrity.
- Diagnostic imaging, particularly CT scans, reveals specific patterns suggestive of IPE.
- Forensic investigations, including autopsy and histology, are crucial for confirming diagnosis in fatal cases.
Implications:
- Early recognition and understanding of IPE are critical for diver safety and medical management.
- Further research into IPE's complex mechanisms may improve diagnostic accuracy and treatment strategies.
- Forensic analysis plays a vital role in determining the cause of death in immersion-related fatalities.
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