Immersion Pulmonary Oedema H015

Current RMA Instruments:

Changes from previous Instruments:

ICD Coding:

• ICD-10-AM Codes: J81.0; T70.8 

Brief description

Immersion pulmonary oedema is a condition in which fluid suddenly builds up in the lungs while a person is swimming or diving. This makes it difficult for oxygen to pass normally from the lungs into the bloodstream.

Symptoms typically develop during immersion and may include sudden or increasing shortness of breath, coughing, coughing up blood or pink frothy sputum, and low blood oxygen levels. The condition can occur in otherwise healthy swimmers or divers and can vary considerably in severity. 

Confirming the diagnosis

The diagnosis is primarily based on the clinical presentation, particularly the development of acute pulmonary oedema while swimming or diving. Relevant investigations may demonstrate low blood oxygen levels and evidence of pulmonary oedema on chest imaging.

There is no single specific diagnostic test for immersion pulmonary oedema. Assessment should consider the circumstances in which symptoms developed and whether another cause of acute pulmonary oedema better explains the presentation.

Diagnostic confirmation by a specialist doctor is required. Depending on the circumstances, assessment by an emergency physician, respiratory physician, cardiologist or diving medicine physician may be appropriate.

Additional diagnoses covered by SOP

• Diving-related immersion pulmonary oedema
• Swimming-induced pulmonary oedema

Conditions not covered by SOP

• Pulmonary oedema due to pulmonary decompression sickness *
• Pulmonary oedema due to acute myocardial infarction *
• Pulmonary oedema due to an acute exacerbation of chronic heart failure *
• Pulmonary oedema from other causes #

* another SOP applies - the SOP has the same name unless otherwise specified

# non-SOP condition

Clinical onset

The onset should generally be based on the earliest symptoms or signs of pulmonary oedema occurring during the relevant swimming or diving activity. Symptoms typically include breathlessness and cough and may include coughing up blood, pink frothy sputum and low blood oxygen levels.

Clinical worsening

Immersion pulmonary oedema is an acute condition that will generally improve following removal from the water and appropriate treatment. Severity varies, and some episodes may require oxygen therapy or more intensive respiratory support. Recurrent episodes of immersion pulmonary oedema can occur with subsequent swimming or diving. When considering clinical worsening, it is important to distinguish deterioration occurring as part of the initial acute episode from a separate subsequent episode.