PMC8592091_01
Imaging of a 71-year-old man with severe immersion pulmonary edema while scuba diving after heavy alcohol intake. A, Chest radiography on admission, with the patient in the half-sitting position. The image shows large butterfly-shaped shadows in both lungs. The lung pattern is seen to be expanding to the right side. The right costophrenic angle is slightly blunted; however, the cardiothoracic ratio does not appear increased. B, C, Computed tomography images of the lung on admission. Multiple focal ground-glass shadows are apparent bilaterally in the middle lobe; thickening of the bronchovascular bundle and the interlobular septum are observed. D, Chest radiography at day 3 of hospitalization, with the patient in the sitting position. The butterfly-shaped shadow has disappeared; however, the thickening of the right major fissure remains. An infiltrative shadow is observed in the lower right lung field, and the line of the descending aorta overlapping the left fourth arch is obscured.
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Chest radiography revealed a butterfly-shaped shadow (Fig. 1A), and chest computed tomography showed thickening of the bronchovascular bundle, bilateral infiltrative lower lobe shadows, and minor bilateral pleural effusions (Fig. 1B, C). The patient was weaned from mechanical ventilation, and the butterfly-shaped radiographic shadow disappeared on day 3 of hospitalization (Fig. 1D).