The case is reported of a physically fit man, who, while training for a triathlon, developed pulmonary oedema secondary to swimming in cold water. Pulmonary oedema is usually caused by a combination of exercise and cold water, resulting in an increase in cardiac preload and after load, which causes an increase in pulmonary capillary pressure. Most cases improve spontaneously and quickly with no recurrence of symptoms. CASE REPORTA 36 year old man was admitted to our hospital complaining of shortness of breath and haemoptysis. He was physically fit and training for a local triathlon competition when the problem occurred. He had been swimming in the sea, wearing a wet suit, for about 10 minutes when he started to feel slightly short of breath. He loosened his wet suit and let the cold water in. However, his breathing worsened. He continued to swim for half a mile more. He started to cough up blood stained sputum. He returned to the shore at this stage and was more short of breath. He denied aspirating any seawater. He borrowed his daughter's salbutamol inhaler and took a few puffs. He presented to his general practitioner about 90 minutes after the incident. The general practitioner heard crackles on his right side and referred him to hospital. He presented to the hospital 8-9 hours after the incident.He is known to have had type 1 diabetes for 13 years treated with insulin. He is a non-smoker, drinks about 4 units of alcohol a week, and works as a pharmacist.On admission to the ward, he was comfortable at rest. His blood pressure was 125/73 mm Hg, pulse 60/min, and oxygen saturation 94% on room air. Jugular venous pressure was not raised, and there was no pedal oedema. There were crackles on the right side of the chest. Cardiovascular examination was normal with no murmur heard.He improved quickly on the ward and was asymptomatic with no drugs prescribed. INVESTIGATIONSThe following are the results of the investigations carried out.

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