Swimming-Induced Pulmonary Edema (SIPE)
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High confidence
- Age: 26
- Sex: Male
- Modality: X-ray
- Region: Chest
- Country: N/A
- State: N/A
- City: N/A
- Diagnosis: Swimming-Induced Pulmonary Edema (SIPE)
🧠 AI Suggestion
1) Findings:
- Adequate inspiratory chest X-ray with clear visualization of both lungs, mediastinum, and diaphragm.
- Cardiac silhouette is normal in size; cardiac apex lies image-right (patient-left), consistent with expected anatomy.
- Pulmonary vasculature appears mildly prominent centrally, with increased perihilar markings suggestive of vascular congestion.
- Subtle hazy ground-glass type opacities noted in the perihilar regions, extending outward in a symmetric pattern (more conspicuous centrally than at the periphery).
- No focal lobar consolidation, no pleural effusion, and no pneumothorax identified.
- Costophrenic angles appear sharp bilaterally.
- Bony thorax visualized without acute abnormality.
2) Most likely diagnosis and why:
Findings are most consistent with pulmonary edema. The hazy bilateral perihilar opacities and vascular congestion suggest an interstitial/alveolar fluid process consistent with pulmonary edema rather than focal pneumonia or chronic interstitial disease. The absence of cardiomegaly makes non-cardiogenic causes more likely (such as swimming-induced pulmonary edema). Context consistency: Consistent — the described clinical context (young swimmer with acute onset) aligns well with non-cardiogenic pulmonary edema findings. Confidence: 80%.
3) Next best diagnostic step:
A confirmatory and more sensitive imaging test would be chest CT to exclude alternative causes of interstitial/alveolar infiltrates and better evaluate for edema distribution. Bedside lung ultrasound could also demonstrate B-lines supporting alveolar-interstitial edema. Concurrently, clinical correlation with oxygen saturation and symptoms is critical.
4) Key differential or confirmatory test:
Differentials include viral/atypical pneumonia, aspiration, and other causes of acute lung injury. A confirmatory test would be echocardiography to exclude cardiogenic causes if history or exam suggests cardiac dysfunction. Measurement of BNP can also help differentiate cardiogenic from non-cardiogenic pulmonary edema.
5) Possible treatment or management:
Management focuses on supportive therapy: oxygen supplementation, careful monitoring, and cessation of strenuous activity/swimming. In SIPE, symptoms usually resolve quickly with rest and oxygen. If severe respiratory distress occurs, noninvasive ventilation or intubation may be required. Long-term, patients may benefit from counseling about SIPE recurrence risk and strategies for prevention during swimming or diving activities
- Adequate inspiratory chest X-ray with clear visualization of both lungs, mediastinum, and diaphragm.
- Cardiac silhouette is normal in size; cardiac apex lies image-right (patient-left), consistent with expected anatomy.
- Pulmonary vasculature appears mildly prominent centrally, with increased perihilar markings suggestive of vascular congestion.
- Subtle hazy ground-glass type opacities noted in the perihilar regions, extending outward in a symmetric pattern (more conspicuous centrally than at the periphery).
- No focal lobar consolidation, no pleural effusion, and no pneumothorax identified.
- Costophrenic angles appear sharp bilaterally.
- Bony thorax visualized without acute abnormality.
2) Most likely diagnosis and why:
Findings are most consistent with pulmonary edema. The hazy bilateral perihilar opacities and vascular congestion suggest an interstitial/alveolar fluid process consistent with pulmonary edema rather than focal pneumonia or chronic interstitial disease. The absence of cardiomegaly makes non-cardiogenic causes more likely (such as swimming-induced pulmonary edema). Context consistency: Consistent — the described clinical context (young swimmer with acute onset) aligns well with non-cardiogenic pulmonary edema findings. Confidence: 80%.
3) Next best diagnostic step:
A confirmatory and more sensitive imaging test would be chest CT to exclude alternative causes of interstitial/alveolar infiltrates and better evaluate for edema distribution. Bedside lung ultrasound could also demonstrate B-lines supporting alveolar-interstitial edema. Concurrently, clinical correlation with oxygen saturation and symptoms is critical.
4) Key differential or confirmatory test:
Differentials include viral/atypical pneumonia, aspiration, and other causes of acute lung injury. A confirmatory test would be echocardiography to exclude cardiogenic causes if history or exam suggests cardiac dysfunction. Measurement of BNP can also help differentiate cardiogenic from non-cardiogenic pulmonary edema.
5) Possible treatment or management:
Management focuses on supportive therapy: oxygen supplementation, careful monitoring, and cessation of strenuous activity/swimming. In SIPE, symptoms usually resolve quickly with rest and oxygen. If severe respiratory distress occurs, noninvasive ventilation or intubation may be required. Long-term, patients may benefit from counseling about SIPE recurrence risk and strategies for prevention during swimming or diving activities
📑 Guidelines Summary (uploaded diagnosis) — Swimming-Induced Pulmonary Edema (SIPE)
Imaging choices for pleural effusion or pleural disease depend on acuity, suspected cause, and presence of concerning clinical features.
- Chest radiograph is first-line for newly suspected pleural effusion or pleural abnormality.
- Ultrasound is preferred for guiding thoracentesis or distinguishing effusion from pleural thickening.
- CT chest without contrast helps characterize pleural fluid, masses, or calcification when malignancy or chronic disease is suspected.
- Contrast-enhanced CT can evaluate pleural enhancement, nodularity, or suspected empyema and malignancy.
- Do not routinely image small, stable, clearly transudative effusions without concerning features.
- MRI chest is useful when CT findings are equivocal for pleural tumor, invasion, or chest wall involvement.
- Consider CT pulmonary angiography if concurrent pulmonary embolism is suspected causing effusion.
- Reimage with CT after treatment if effusion persists or atypical features raise concern for underlying malignancy.
- Red flags: loculated effusion, hemothorax, rapid reaccumulation, or pleural nodularity signal need for advanced imaging.
- Pitfalls include mistaking subpulmonic effusion for elevated diaphragm or missing effusion on supine x-ray.
🤖 Guidelines Summary (AI diagnosis) — Workup of Pleural Effusion or Pleural Disease
Guidelines Summary of AI Suggestion diagnosis is the same as the uploaded diagnosis. Please read above.
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