A 69-year-old female was found unconscious after nearly drowning (submersion) in a hot spring spa (Tamagawa spa, Akita prefecture) on June, 2001. The near drowning was associated with acid aspiration. She developed acute respiratory distress syndrome and shock after arrival at our emergency room. She was immediately treated using mechanical ventilation and percutaneous cardiopulmonary support. However, she died on the fourth hospital day as a result of a rapidly progressive lung injury induced by acid aspiration. Lung CT images demonstrated heterogeneous pulmonary infiltrations with irregularly fused cavities. An autopsy showed marked degeneration of the alveolar epithelium and abnormal deposits within the alveoli.
