Pulmonary bulla and sudden death in a young aeroplane passenger

We report a case of a young passenger who during a flight in an aeroplane suddenly lost consciousness and eventually died. The only pathologic finding was a lung bulla. The routine decompression in the passenger room during the flight may have caused expansion of the bulla with mediastinal compression or an increase of the pressure inside the bulla above lung bursting pressure resulting in systemic air embolism. Both mechanisms could have caused the patient's sudden collapse.