Thoracic manifestations of inhalational injury caused by the Whakaari/White Island eruption

Introduction Thoracic imaging of people who have survived exposure to a volcanic pyroclastic flow has not been described. In December 2019, an active volcano in New Zealand erupted with loss of life and severe burns to groups of people who were within one kilometre of a new fissure. Our aim was to describe the range of pulmonary abnormality in patients admitted to the Burns unit at Middlemore Hospital. Methods We describe the initial radiographic and computed tomography (CT) appearance of lung injuries in 14 people close to this fissure who were transported to our national burns centre in Middlemore hospital. We compared these appearances with bronchoscopy findings and A-a gradients as a measure of oxygen utilisation. Results All patients had chest radiographs and eight had CT scans within two days after admission. Nine had bronchoscopies within the first week. Two were repatriated to Australia, one of whom did not survive. Two died within 3 days after admission, and the remaining ten patients survived the first week. Eight patients required ongoing ventilation, seven of whom had abnormal CXRs or CT scans on admission. Two of these patients developed an ARDS pattern of oedema reflecting lung injury from the toxic surge but they recovered. In the five patients who survived the first week with relatively minor evidence of lung injury, bibasal atelectasis was the most common finding. Conclusion Pyroclastic flow effect caused a variety of lung abnormalities most likely due to toxic gas emissions. Upper airway burns were seen at bronchoscopy in only 5 patients. An ARDS response in the lungs of two patients improved within three months.