Diagnosis of Swimming Induced Pulmonary Edema—A Review

Abstract

Swimming induced pulmonary edema (SIPE) is a complication that can occur during exercise with the possibility of misdiagnosis and can quickly become life threatening; however, medical literature infrequently describes SIPE. Therefore, the aim of this review was to analyse all individual cases diagnosed with SIPE as reported in scientific sources, with an emphasis on the diagnostic pathways and the key facts resulting in its diagnosis. Due to a multifactorial and complicated pathophysiology, the diagnosis could be difficult. Based on the actual literature, we try to point out important findings regarding history, conditions, clinical findings, and diagnostic testing helping to confirm the diagnosis of SIPE. Thirty-eight cases from seventeen articles reporting the diagnosis of SIPE were selected. We found remarkable differences in the individual described diagnostic pathways. A total of 100% of the cases suffered from an acute onset of breathing problems, occasionally accompanied by hemoptysis. A total of 73% showed initial hypoxemia. In most of the cases (89%), an initial chest X-Ray or chest CT was available, of which one-third (71%) showed radiological signs of pulmonary edema. The majority of the cases (82%) experienced a rapid resolution of symptoms within 48 h, the diagnostic hallmark of SIPE. Due to a foreseeable increase in participation in swimming competitions and endurance competitions with a swimming component, diagnosis of SIPE will be important, especially for medical teams caring for these athletes.

Occurrence, Risk Factors, Prognosis and Prevention of Swimming-Induced Pulmonary Oedema: a Systematic Review

“…The representativeness of participants is also unclear. Our findings in relation to early recovery correspond with those of a recent summary of published case reports in which symptoms resolved within 48 h in 31 out of 38 reports (the symptoms persisting after 48 h in 7 non-resolved cases were not described) [31]. Adir et al [12] suggested their findings of restrictive lung function deficit that persisted for a week following SIPE may indicate persistent pulmonary oedema and damage to capillaries; however, no symptoms and/or spirometric outcomes after this period were reported by the authors, so it is unclear how long the lung function deficit lasted or whether the participants had any clinical problems.…”

Complete upper airway collapse and apnoea during tethered swimming in horses

“…Nicholl et al (1978) further described the period of apnoea as being associated with a raised upper lip, flattening of the alar folds and closure of the airways; however, this observation has not been confirmed by endoscopic examination .The effect of swimming on the occurrence of EIPH is also unclear. Swimming‐induced pulmonary oedema and haemoptysis is a recognised phenomenon in human athletes . There are anecdotal reports of horses experiencing epistaxis following swimming , yet the source of the bleeding is uncertain and has been suggested that it arises from the nasopharynx in some cases .…”

The need for systematic diagnosis of exercise-induced respiratory syndromes: the example of swimming-induced pulmonary edema

“…In a recent review of the existing literature regarding SIPE [7], we concluded that this complication has a difficult diagnosis. Thus, it is necessary to consider the history and clinical presentation of the patient combined with the administration of diagnostic tests such as oxygen saturation, pulmonary function tests, and radiological examination [8].…”