title: Pulmonary barotrauma and arterial gas embolism caused by an emphysematous bulla in a SCUBA diver.
abstract: A 23-year-old female self-contained underwater breathing apparatus (SCUBA) diver developed central nervous symptoms and signs of arterial gas embolism when surfacing after 15 min at a depth of 18 m. The dive had been performed according to normal procedure. In the hospital, chest X-ray and computer tomography of the chest showed a large emphysematous bulla in the left hemithorax. Recompression treatment was not performed. Reexamination of old X-rays showed an emphysematous bulla on the left side which had been present before the dive. She made a complete recovery. Emphysematous bullae may be a more common cause of pulmonary barotrauma than is realised. Bullae visible on computer tomograms or magnetic resonance imaging may not be visible on conventional X-rays. The case reported illustrates the need for a consensus on the procedures necessary for the medical screening of diving candidates.
authors.affiliation: Department of Pulmonary Medicine, Ullevål Hospital, Oslo, Norway.
authors.forename: H
authors.initials: H
authors.lastname: Mellem
authors.forename: S
authors.initials: S
authors.lastname: Emhjellen
authors.forename: O
authors.initials: O
authors.lastname: Horgen
mesh_terms: D000328:Adult; D001158:Arteries; D001469:Barotrauma / Q000209:etiology*; D004242:Diving / Q000009:adverse effects*; D004618:Embolism, Air / Q000000981:diagnostic imaging / Q000209:etiology*; D005260:Female; D006801:Humans; D055370:Lung Injury; D011656:Pulmonary Emphysema / Q000150:complications* / Q000000981:diagnostic imaging; D011859:Radiography