Breath-hold diving, also known as free-diving, describes the practice of intentional immersion under water without an external supply of
oxygen. Pulmonary
hemorrhage with
hemoptysis has been reported as a complication of immersion and breath-hold diving in young healthy athletes. We report the case of a 60-year-old man with a history of radiation and
chemotherapy for
breast carcinoma, who developed the abrupt onset of
hemoptysis in the setting of swimming and breath-hold diving. A computed tomography (CT) scan of the chest demonstrated an area of ground glass opacification, suggestive of pulmonary
hemorrhage, superimposed on a background of reticular opacities within the prior radiation field. A follow-up CT scan of the chest, obtained 2 months after presentation, demonstrated resolution of the ground glass opacification, but persistence of fibrotic features attributable to prior
radiation therapy. We postulate that prior irradiation of the chest resulted in
lung injury and
fibrosis which, in turn, rendered the affected region of the lung susceptible to "stress failure," due to an increase in the transcapillary pressure gradient arising from immersion and breath-hold diving. Patients with a history of
lung injury resulting from chest irradiation should be cautioned about pulmonary
hemorrhage and
hemoptysis as a potential complication of swimming and breath-hold diving.