American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: Editor-in-chief: Samy, I. McFarlane
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American Journal of Medical Case Reports. 2020, 8(7), 173-177
DOI: 10.12691/ajmcr-8-7-3
Open AccessCase Report

Snorkeling Induced Pulmonary Edema: A Case Report and Review of the Literature

Ruchi Yadav1, Pramod Theetha Kariyanna1, Dommalur Jayarangaiah2, Delroy Thomas3, Vivek Yadav4, Ashkan Tadayoni1, Lyudmila Aurora1, Benjamin Ramalanjaona1 and Isabel M. McFarlane1,

1Division of Cardiovascular Diseases and Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, U.S.A

2Division of Internal Medicine, The American University of St Vincent, B210-5145, Steeles Ave. W. Toronto, ON M9L 1R5, Canada

3Milton Cato Memorial Hospital, Kingstown, Saint Vincent and the Grenadines VC0130

4Department of Internal Medicine, Brookdale University Hospitals and Medical Center, 1 Brookdale Plaza, Brooklyn, New York, NY 11212, USA

Pub. Date: April 14, 2020

Cite this paper:
Ruchi Yadav, Pramod Theetha Kariyanna, Dommalur Jayarangaiah, Delroy Thomas, Vivek Yadav, Ashkan Tadayoni, Lyudmila Aurora, Benjamin Ramalanjaona and Isabel M. McFarlane. Snorkeling Induced Pulmonary Edema: A Case Report and Review of the Literature. American Journal of Medical Case Reports. 2020; 8(7):173-177. doi: 10.12691/ajmcr-8-7-3


Swimming-induced pulmonary edema (SIPE), also called immersion pulmonary edema (IPE), is a medical condition seen in various water-based activities such as scuba diving, swimming, aqua jogging, triathlete competition and snorkeling. It occurs when transcapillary filtration of low protein fluid collects in the lungs, in the absence of water aspiration during an aquatic activity, causing acute dyspnea, cough and/or hemoptysis. The hallmark of this entity is the complete resolution of symptoms within 48 hours. SIPE in snorkeling is an under-reported and understudied subject. The true prevalence of SIPE is unknown with an estimated range from 1.8-60% among combat swimmers trainee and 1.4% in triathletes. Recent developments have been done in elucidating the pathophysiology of SIPE with regards to pulmonary capillary pressure so that the predisposing factors and potential causes can be targeted. SIPE can be a potentially life-threatening condition, which needs to be recognized by the swimmers, divers, supervising physicians in order to diagnose and manage it promptly. We report a rare case of SIPE in snorkeling which presented with acute respiratory symptoms and managed with supportive measures in the hospital.

pulmonary edema immersion pulmonary edema snorkeling swimming athletes

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[1]  Smith R, Ormerod JOM, Sabharwal N, Kipps C. Swimming-induced pulmonary edema: current perspectives [Internet]. Open Access Journal of Sports Medicine. 2018 [cited 2020 Feb 16]. Available from:
[2]  Swimming-Induced Pulmonary Edema - American College of Cardiology [Internet]. [cited 2020 Feb 16]. Available from:
[3]  Shupak A, Weiler-Ravell D, Adir Y, Daskalovic YI, Ramon Y, Kerem D. Pulmonary oedema induced by strenuous swimming: a field study. Respir Physiol. 2000 Jun; 121(1): 25-31.
[4]  Pons M, Blickenstorfer D, Oechslin E, Hold G, Greminger P, Franzeck UK, et al. Pulmonary oedema in healthy persons during scuba-diving and swimming. Eur Respir J. 1995 May; 8(5): 762-7.
[5]  Boussuges A, Ayme K, Chaumet G, Albier E, Borgnetta M, Gavarry O. Observational study of potential risk factors of immersion pulmonary edema in healthy divers: exercise intensity is the main contributor. Sports Med - Open. 2017 Oct 3; 3(1): 35.
[6]  Grünig H, Nikolaidis PT, Moon RE, Knechtle B. Diagnosis of Swimming Induced Pulmonary Edema—A Review. Front Physiol [Internet]. 2017 Aug 31 [cited 2020 Feb 16];8. Available from:
[7]  Adir Y, Shupak A, Gil A, Peled N, Keynan Y, Domachevsky L, et al. Swimming-induced pulmonary edema: clinical presentation and serial lung function. Chest. 2004 Aug; 126(2): 394-9.
[8]  8. Cochard G, Henckes A, Deslandes S, Noël-Savina E, Bedossa M, Gladu G, et al. Swimming-induced immersion pulmonary edema while snorkeling can be rapidly life-threatening: Case reports. Undersea Hyperb Med J Undersea Hyperb Med Soc Inc. 2013 Sep 1; 40: 411-6.
[9]  Yamamoto I, Yamashiro S, Nagano H, Kishaba T, Nei Y, Kinjo K. Immersion Pulmonary Edema During Snorkeling: A Case Report. In: C53 PULMONARY TOXICOLOGY AND CASE REPORTS [Internet]. American Thoracic Society; 2015 [cited 2020 Feb 16]. p. A4670–A4670. (American Thoracic Society International Conference Abstracts). Available from:
[10]  Choo DM, Kim SS, Chung CU, Park DI, Kim JH. Snorkeling-Induced Pulmonary Hemorrhage: A Case Report. J Korean Soc Radiol. 2017 Nov 1; 77(5): 344-7.
[11]  Ionescu RC, Khan BA, Farber MO, Sigua NL. Snorkeling, A Rare Cause Of Diffuse Alveolar Hemorrhage In A Healthy Swimmer. In: D103 CASE REPORTS: GENERAL PULMONARY [Internet]. American Thoracic Society; 2012 [cited 2020 Feb 17]. p. A6594–A6594. (American Thoracic Society International Conference Abstracts). Available from:
[12]  Hageman SM, Murphy-Lavoie HM. Immersion Pulmonary Edema. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 [cited 2020 Feb 17]. Available from:
[13]  Miller CC, Calder-Becker K, Modave F. Swimming-induced pulmonary edema in triathletes. Am J Emerg Med. 2010 Oct; 28(8): 941-6.
[14]  Spencer S, Dickinson J, Forbes L. Occurrence, Risk Factors, Prognosis and Prevention of Swimming-Induced Pulmonary Oedema: a Systematic Review. Sports Med - Open. 2018 Sep 20; 4(1): 43.
[15]  Vinkel J, Bak P, Juel Thiis Knudsen P, Hyldegaard O. Forensic Case Reports Presenting Immersion Pulmonary Edema as a Differential Diagnosis in Fatal Diving Accidents. J Forensic Sci. 2018 Jan; 63(1): 299-304.
[16]  Ludwig BB, Mahon RT, Schwartzman EL. Cardiopulmonary function after recovery from swimming-induced pulmonary edema. Clin J Sport Med Off J Can Acad Sport Med. 2006 Jul; 16(4): 348-51.
[17]  (PDF) Immersion Pulmonary Edema [Internet]. [cited 2020 Feb 17]. Available from:
[18]  Wester TE, Cherry AD, Pollock NW, Freiberger JJ, Natoli MJ, Schinazi EA, et al. Effects of head and body cooling on hemodynamics during immersed prone exercise at 1 ATA. J Appl Physiol Bethesda Md 1985. 2009 Feb; 106(2): 691-700.
[19]  Moon RE, Martina SD, Peacher DF, Potter JF, Wester TE, Cherry AD, et al. Swimming-Induced Pulmonary Edema: Pathophysiology and Risk Reduction With Sildenafil. Circulation. 2016 Mar 8; 133(10): 988-96.
[20]  Tsukimoto K, Mathieu-Costello O, Prediletto R, Elliott AR, West JB. Ultrastructural appearances of pulmonary capillaries at high transmural pressures. J Appl Physiol Bethesda Md 1985. 1991 Aug; 71(2): 573-82.
[21]  Lund KL, Mahon RT, Tanen DA, Bakhda S. Swimming-induced pulmonary edema. Ann Emerg Med. 2003 Feb; 41(2): 251-6.
[22]  Casey H, Dastidar AG, MacIver D. Swimming-induced pulmonary oedema in two triathletes: a novel pathophysiological explanation. J R Soc Med. 2014 Nov; 107(11): 450-2.
[23]  Smith R, Brooke D, Kipps C, Skaria B, Subramaniam V. A case of recurrent swimming-induced pulmonary edema in a triathlete: the need for awareness. Scand J Med Sci Sports. 2017 Oct; 27(10): 1130-5.
[24]  Coulange M, Rossi P, Gargne O, Gole Y, Bessereau J, Regnard J, et al. Pulmonary oedema in healthy SCUBA divers: new physiopathological pathways. Clin Physiol Funct Imaging. 2010 May; 30(3): 181-6.
[25]  Wilmshurst PT, Nuri M, Crowther A, Webb-Peploe MM. Cold-induced pulmonary oedema in scuba divers and swimmers and subsequent development of hypertension. Lancet Lond Engl. 1989 Jan 14; 1(8629): 62-5.
[26]  Weiler-Ravell D, Shupak A, Goldenberg I, Halpern P, Shoshani O, Hirschhorn G, et al. Pulmonary oedema and haemoptysis induced by strenuous swimming. BMJ. 1995 Aug 5; 311(7001): 361-2.
[27]  Carter EA, Koehle MS. Immersion Pulmonary Edema in Female Triathletes. Pulm Med [Internet]. 2011 [cited 2020 Feb 17]; 2011. Available from:
[28]  Gempp E, Demaistre S, Louge P. Hypertension is predictive of recurrent immersion pulmonary edema in scuba divers. Int J Cardiol. 2014 Mar 15; 172(2): 528-9.
[29]  Alonso JV, Chowdhury M, Borakati R, Gankande U. Swimming-induced pulmonary oedema an uncommon condition diagnosed with POCUS ultrasound. Am J Emerg Med. 2017 Dec; 35(12): 1986.e3-1986.e4.
[30]  Reversible myocardial dysfunction and clinical outcome in scuba divers with immersion pulmonary edema. - Abstract - Europe PMC [Internet]. [cited 2020 Feb 18]. Available from:
[31]  Marlinge M, Deharo P, Joulia F, Coulange M, Vairo D, Gaudry M, et al. Troponins in scuba divers with immersion pulmonary edema. Biosci Rep [Internet]. 2018 Sep 28 [cited 2020 Feb 18];38(5). Available from:
[32]  Louge P, Coulange M, Beneton F, Gempp E, Le Pennetier O, Algoud M, et al. Pathophysiological and diagnostic implications of cardiac biomarkers and antidiuretic hormone release in distinguishing immersion pulmonary edema from decompression sickness. Medicine (Baltimore). 2016 Jun; 95(26): e4060.
[33]  Groshaus HE, Manocha S, Walley KR, Russell JA. Mechanisms of beta-receptor stimulation-induced improvement of acute lung injury and pulmonary edema. Crit Care Lond Engl. 2004 Aug; 8(4): 234-42.
[34]  Kumar M, Thompson PD. A literature review of immersion pulmonary edema. Phys Sportsmed. 2019; 47(2): 148-51.
[35]  Desgraz B, Sartori C, Saubade M, Héritier F, Gabus V. [Immersion pulmonary edema]. Rev Med Suisse. 2017 Jul 12; 13(569): 1324-8.