Radiographie Pulmonary Changes in Near-Drowning

In recent years, with the increased use of water as a recreational facility, accidental deaths due to drowning have multiplied. In the United States, drownings now account for 7 per cent of the total number of accidental deaths, and with greater participation of the population in water sports, this figure will probably increase even further in the future. Romagosa and his co-workers (7) reported one case of near-drowning in 1950, and stated that in reviewing the English and French medical literature since 1915, only 2 reports of radiographic changes in the lungs could be found. Trocmé and Lafarie (13) described 3 cases, and Trocmé and Lebert (12) reported an additional 2 of near-drowning. In a review of the literature since 1950, we have found only one article dealing with the radiologic aspects of near-drowning, that by Reboul and his associates (6). In 1955 they reported the radiographic changes in one patient. Thus, in the literature to date, there are only 7 case reports in man, in which the emphasis is on the radiographic changes. We have recently had the opportunity of studying 10 cases of near-drowning with accompanying x-ray films of the chest taken during the course of the patients' recovery. For comparative purposes, 2 additional cases of drowning and 1 of nonfatal sea-water aspiration are also included. This group comprises a portion of the cases on which the recent articles by Fuller are based (1, 2). The clinical and pathologic aspects of drowning have been well documented, both in animals and man, and therefore will be reviewed only briefly. For our purposes, near-drowning is defined as submersion in which the patient was recovered from the water in a state of apnea and was subsequently resuscitated. Clinical-Pathologic Changes The clinical changes in near-drowning in man have been well described both by Fuller and by Saline and Baum (9). Fever occurred in 27 per cent of Saline's and in 58 per cent of Fuller's cases. It was usually of a minor degree, but occasionally reached 108° F. Leukocytosis with a shift to the left was noted in almost all of Saline's cases and in half of Fuller's. Saline considered that the basis for the leukocytosis was a generalized stress reaction rather than an inflammatory response. Neurologic symptoms were also quite common, consisting chiefly of hyperactivity, confusion, and coma. Return to coma after a lucid interval occurred in 14 of Fuller's cases and was always associated with a fatal outcome. Tachycardia, gallop rhythm, and extrasystoles were the main cardiac abnormalities and were usually relieved by oxygenation. Abdominal distention, caused both by water ingestion and by air pushed into the stomach during resuscitative efforts, was also noted and frequently led to vomiting. In some instances this delayed vomiting caused further aspiration of gastric contents and a delayed recovery.