Computed tomography of the chest in diving-related pulmonary barotrauma

Arterial gas embolism due to barotrauma of the lungs is a severe complication in compressed air diving. Precipitating factors are often missed on plain chest radiology. This study was conducted to detect occult lung disease predisposing to the development of pulmonary barotrauma in conditions associated with a change in ambient pressure. During the past 4 years, 11 patients who have suffered pulmonary barotrauma with or without subsequent development of cerebral or spinal arterial gas embolism underwent computed tomography of the chest several days post-injury. Examinations were conducted either using the conventional technique (n = 7) or, more recently, in the spiral mode (n = 4). Chest radiographs were available in all cases. In five patients CT revealed subpleural emphysematous blebs or cysts that were not detected by conventional radiography. Follow-up studies performed in two of these cases several months post-injury showed that the cystic lesions did not resolve. We assume that the lung cysts or blebs are preexisting conditions which caused pulmonary barotrauma. Computed tomography of the chest, preferably in the spiral mode, is recommended in any case of suspected pulmonary barotrauma in order to evaluate the possibility of pre-existing pathology and to predict future fitness to dive.