Cerebral arterial gas embolism in a scuba diver with a primary lung bulla

Primary lung bullae have been reported to cause pulmonary barotrauma and lead to cerebral arterial gas embolism (CAGE) in the context of diving; however, a lack of symptoms and often minimal radiographic findings often preclude a diagnosis of lung bullae prior to undertaking diving activity. We present the case of a healthy 27-year-old Caucasian male who presented following the second of two introductory resort dives with neurological symptoms attributable to CAGE. Investigations revealed a previously undiagnosed large primary lung bulla. This case highlights the clinical sequelae of primary lung bullae in the context of pulmonary barotrauma related to recreational diving activity.