CTICasesSand Bronchograms from Surf Aspiration (Near-Drowning in Ocean)
Imaging findings
Chest radiograph from a patient in Hawaii who was tumbled by a large wave shows diffuse bilateral pulmonary opacities. CT on soft-tissue windows demonstrates high-attenuation branching structures filling the bronchi bilaterally, corresponding to aspirated sand particles (predominantly quartz). The sand fills the airway tree in a bronchographic pattern on CT. Lung windows confirm bilateral consolidation around the sand-filled airways from surrounding pulmonary edema and hemorrhage.
Key takeaways
Near-drowning in the ocean from a large wave can result in aspiration of sand-laden water, with the sand particles (quartz and other minerals) being sufficiently radio-opaque to produce high-attenuation bronchograms on CT, termed sand bronchograms. This is analogous to the gravel aspiration cases seen in freshwater near-drowning and the aspiration of calcium-containing dust in chalk mine workers. The CT appearance of branching high-attenuation material in the airways on soft-tissue windows is pathognomonic when the clinical history of surf aspiration is available.
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