title: Two fatal cases of immersion pulmonary oedema - using dive accident investigation to assist the forensic pathologist.
abstract: Immersion pulmonary oedema (IPE) is being increasingly recognized in swimmers, snorkellers and scuba divers presenting with acute symptoms of respiratory distress following immersion, but fatal case reports are uncommon. We report two fatal cases of probable IPE in middle-aged women, one whilst snorkelling and the other associated with a scuba dive. In the snorkeller's case, an episode of exercise-related chest tightness and shortness of breath that occurred 10 months previously was investigated but this proved negative, and she was on no medications. However, at autopsy, moderate left ventricular hypertrophy was noted. The scuba diver had suffered several previous episodes of severe shortness of breath following dives, one being so severe it led to cyanosis and impaired consciousness. At inquest, the pathologist's diagnosis was given as drowning and IPE was not mentioned. Expert input from doctors trained in diving medicine should be compulsory in the investigation of diving deaths, and forensic pathologists should be properly trained in and have guidelines for the conduct of post-immersion and post-diving autopsies.
authors.affiliation: Clinical Associate Professor, Faculty of Heath Sciences, University of Tasmania, and Medical Co-director, Department of Diving and Hyperbaric Medicine, Royal Hobart Hospital, Hobart, Tasmania 7000, Australia, Phone: +61-(0)3-6222-8193, Fax: +61-(0)3-6222-7268, E-mail: david.smart@dhhs.tas.gov.au.
authors.forename: David R
authors.initials: DR
authors.lastname: Smart
authors.affiliation: Consultant Forensic Pathologist with the New Zealand National Forensic Pathology Service, Christchurch, New Zealand.
authors.forename: Martin
authors.initials: M
authors.lastname: Sage
authors.affiliation: Formerly Medical Director (now retired), Hyperbaric Medicine Unit, Christchurch Hospital, Christchurch, New Zealand.
authors.forename: F Michael
authors.initials: FM
authors.lastname: Davis
mesh_terms: D001344:Autopsy; D004242:Diving / Q000009:adverse effects*; D004417:Dyspnea / Q000150:complications; D017809:Fatal Outcome; D005260:Female; D049429:Forensic Pathology; D006333:Heart Failure / Q000473:pathology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000473:pathology; D007101:Immersion / Q000009:adverse effects*; D008875:Middle Aged; D005082:Physical Exertion; D011654:Pulmonary Edema / Q000209:etiology / Q000473:pathology*; D014474:Unconsciousness / Q000209:etiology
keywords: Immersion; autopsy, coroner’s findings,; case reports; coroner's findings; deaths; pulmonary oedema; scuba diving; snorkelling