Fatal pulmonary decompression sickness: a case report

A 51-year-old civilian pilot flying a high performance aircraft for the USAF presented for medical attention approximately 1.5 hours after developing substernal chest pain and dyspnea while flying unpressurized at FL 280 (8,534 meters) for 30 minutes. In spite of recompression about 3 hours later, the pilot expired while ascending from 6 atmospheres, 2.5 hours into the dive. This represents the first reported fatality due to altitude-induced decompression sickness since 1959. Pathologically, this case is similar to cases presented in the past. In addition, this case serves to reemphasize many of the "risk factors" for decompression sickness, especially age and obesity. Furthermore, the evidence presented points to maintaining only the highest standards of physical health in those who fly high performance aircraft.