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ABSTRACT
Swimming-induced pulmonary edema occurs when fluid accumulates in the lungs in the absence of water aspiration during swimming and produces acute shortness of breath and a cough with blood-tinged sputum. We report a case of a 58-year-old female athlete presenting with acute dyspnea during the swimming portion of a half-triathlon competition. She had complete resolution within 24 h of presentation.
KEYWORDS Athlete; cold water; immersion pulmonary edema; swimming; triathlon
Swimming-induced pulmonary edema (SIPE) is a type of pulmonary edema that occurs during surface or underwater swimming and causes the accumulation of fluid in the lungs without water aspiration and consequently symptoms of pulmonary edema.1,2 It has an estimated prevalence of 1.4% among triathletes.1 We report a patient with acute dyspnea during the swimming portion of a half-triathlon competition.
CASE DESCRIPTION
A 58-year-old white woman presented with sudden dyspnea associated with cough productive of frothy pink sputum that began while swimming during a half-triathlon competition. After being pulled out of the water, she received bronchodilator treatments without improvement. She denied water aspiration. Her blood pressure was 133/87 mm Hg; heart rate, 102 beats per minute; respiratory rate, 24 breaths per minute; temperature, 97°F; and oxygen saturation, 83% on room air. She was in moderate respiratory distress but had no laryngospasm. She had scant bibasilar crackles and no lower limb edema. The chest radiograph showed bilateral alveolar infiltrates consistent with pulmonary edema (Figure 1a). Her cardiac enzymes were normal, and the brain natriuretic peptide level was 126 pg/mL (normal < 124 pg/mL). A transthoracic echocardiogram showed normal systolic and diastolic function with trace mitral and tricuspid regurgitation.
She required respiratory support with bilevel positive airway pressure ventilation and was given 40 mg of furosemide. After 4 h, her oxygen saturation improved, and she was switched to nasal cannula for oxygenation. After 24 h, a second chest radiograph revealed clear lung fields (Figure 1b), she no longer required oxygen, and her symptoms had resolved.
DISCUSSION
SIPE is an unusual complication that can occur during heavy exercise in water. It is often misdiagnosed and can rapidly deteriorate into life-threatening situations.3 Moon et al identified 58 deaths between October 2008 and November 2015 in the United States and Canada in triathletes during training or competition; 42 deaths...