Shortly after a single 27.4 msw dive for 45 minutes using compressed air in the Red Sea, he suffered acute paraparesis and disturbed conscious level. HistoryĪ 33 year-old male diving instructor with experience (> 600 dives) presented to our facility in 2013. We chose a case for this article with a non-classic history and two concomitant conditions that may precipitate gas embolism to demonstrate the clinical difficulties in diagnosing PBT. It is also worth noting that PBT is a different disorder and is caused by a different mechanism than pulmonary oedema, which is caused by immersion or exhaustion (swimmers lung oedema), where body fluids permeate into the alveolar space and impede gas exchange through the alveolar wall precipitating dyspnea, blood tinged expectoration and respiratory distress. Our centre also received cases of PBT caused by heavily straining under water while working on a mooring line or retrieving heavy objects. PBT of ascent occurs among recreational divers who have pre-existing lung diseases whether obstructive, neoplastic, granulomatous or congenital. There are reports of PBT of ascent occurring in free or buoyant ascents as in submarine escape training which is not a common practice in recreational diving. Hence, conditions or diseases that impede flow of air leaving the lung or causing air trapping may pose a serious health hazard to a scuba diver, spontaneous pneumothorax cases, active asthmatics, cavitating lesions and emphysema, and COPD cases. Gas embolism occurs when air leaks into the blood vessels. If air leaks under the skin, it will cause surgical emphysema. Leakage of air into the chest cavity will cause a pneumothorax, if it leaks into the pericardium, a pneumo-pericardium or mediastinal emphysema can occur. Leakage of the air from the lungs can present in different ways, depending on the anatomical location.
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