A case of immersion pulmonary edema that developed while snorkeling

Abstract

Immersion pulmonary edema is a disease that causes pulmonary edema and is associated with swimming. Here, we present a case of a patient with immersion pulmonary edema that developed during snorkeling. A man in his forties became aware of respiratory distress while snorkeling and visited our hospital. Upon arrival, his saturation of percutaneous oxygen was 88％, and a chest CT showed bilateral ground-glass opacities and mottled infiltrate shadows, with findings of pulmonary edema. He stated that he did not aspirate water; therefore, drowning was ruled out, and we diagnosed him with immersion pulmonary edema. After admission, non-invasive positive pressure ventilation was initiated, the hypoxemia quickly improved, and the patient was discharged on the third day. Three of the four patients who were diagnosed with immersion pulmonary edema in our hospital in the three-year period, from 2021 to 2023, were associated with snorkeling. Most reports of immersion pulmonary edema in Japan are associated with diving, and there remains little awareness that immersion pulmonary edema can occur regardless of diving depth. A detailed medical history is important to distinguish this condition from drowning or decompression sickness.