CTICasesNear-Drowning with Gravel Aspiration and Bronchiolitis
Imaging findings
Chest radiograph shows bilateral pulmonary opacities in a young drowning victim. CT performed on soft-tissue windows reveals high-attenuation material in the bronchial tree corresponding to aspirated gravel particles, which were subsequently suctioned out bronchoscopically. Lung windows demonstrate dramatic bilateral tree-in-bud nodularity consistent with intense bronchiolitis from water aspiration and subsequent pulmonary infections. There is also high-attenuation material in the stomach on abdominal imaging consistent with swallowed lake bed debris.
Key takeaways
Near-drowning in a lake or body of water can result in aspiration of not only water but also particulate material including gravel and lake bed debris, which can be visualized as high-attenuation branching structures in the bronchi on soft-tissue CT windows. This produces intense bronchiolitis and is associated with severe pulmonary infections and hypoxemia. The case illustrates that aspirated mineral material has a distinct CT appearance similar to the sand bronchograms previously described with surf-related sand aspiration.
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