Israel Medical Association Journal

Background: The Dead Sea is a hypersaline lake with unique mineral concentrations. Ingestion and aspiration of its water can lead to severe electrolyte imbalances and chemical pneumonitis.

Objectives: To evaluate imaging findings from Dead Sea near-drowning victims and to correlate these findings with clinical outcomes.

Methods: We conducted a retrospective study of patients (age > 18 years) admitted to a tertiary medical center between 2004 and 2024 following Dead Sea near-drowning. Imaging studies were categorized by a radiology expert into normal, interstitial changes, unilateral consolidation, or bilateral consolidation. Clinical outcomes, including mortality and intensive care unit (ICU) admission, were analyzed across the groups.

Results: Of the 150 patients identified, 68.7% (n=103) had normal chest X-rays. Abnormal findings included bilateral consolidation 12.7% (n=19), unilateral consolidation 9.3% (n=14), and interstitial changes 9.3% (n=14). Patients with bilateral consolidation had significantly higher peak serum magnesium (median 10.5 vs. 3.1 mg/dl in the normal group; P < 0.001) and peak calcium (median 13.1 vs. 10.3 mg/dl; P < 0.001). Bilateral consolidation was a strong predictor of severity: 26.3% in-hospital mortality rate compared to 1% in the group with normal X-rays (P < 0.001). ICU admission was required for 78.9% of patients with bilateral consolidation and 71.4% with interstitial changes (P < 0.001).

Conclusion: Radiologic findings in Dead Sea near-drownings are predictive of clinical trajectory. Bilateral alveolar consolidation is an indication of massive mineral aspiration, severe hypermagnesemia, and high mortality. Early imaging is essential for risk stratification and for determining the level of care required.

Inflammatory myopathies include polymyositis, necrotizing autoimmune myositis, dermatomyositis, juvenile inflammatory myopathy, and inclusion body myositis. These diseases are classified based on the different clinical and pathological characteristics unique to each of them [1]. Dermatomyositis is a rare disease with an incidence of 6–10 cases/1,000,000 a year with the highest incidence in the 7th decade of life as reported by a Norwegian cohort in a Caucasian population [2].

Diagnosis of dermatomyositis is based on typical signs and symptoms combined with laboratory results, imaging, and electromyography findings and muscle biopsy. Historically, the diagnosis of dermatomyositis was based on the classification criteria named after Bohan and Peter published in 1975. Many other classification criteria were proposed subsequently, the latter by the European League Against Rheumatism/American College of Rheumatology (EULAR/ACR), which were published in 2020 [3].

The clinical features of dermatomyositis are diverse. Skin manifestations can accompany or precede muscle weakness. Classical skin findings include periorbital heliotrope rash and a rash of the upper chest, back, and shoulders, known as the V sign and shawl sign respectively, as well as the Gottron's papules on the knuckles. Another skin appearance is subcutaneous calcifications that break periodically through the skin causing ulcerations. Dermatomyositis usually manifests as a symmetrical proximal muscle weakness but can present with preserved strength called amyopathic dermatomyositis [1].