Ice Hockey Lung (Nitrogen Dioxide Pneumonitis)

Nitrogen dioxide is denser than oxygen. The walls of an ice hockey arena help to contain the gas.

The onset of symptoms may be up to 72 hours after the exposure.

Clinical symptoms:

(1) chronic cough

(2) dyspnea

(3) hemoptysis

(4) chest pain

(5) weakness

Symptoms may persist for months after the exposure.

Additional findings:

(1) reduced PEF (peak expiratory flow) and/or a significant bronchodilator response

(2) hypoxemia

(3) abnormal chest X-ray (alveolar consolidation, parenchymal infiltrates)

(4) elevated nitrogen dioxide levels if air monitoring performed

The diagnosis involves exclusion of other causes that could explain the findings. Carbon monoxide poisoning should be considered.