Pneumomediastinum or lung damage in breath-hold divers from different mechanisms: a report of three cases

• Published in: Diving and hyperbaric medicine Vol. 43; no. 4; p. 232
• Main Authors: Toklu, Akin Savaş, Erelel, Mustafa, Arslan, Abdullah
• Format: Journal Article
• Language: English
• Published: Australia 01-12-2013
• Subjects: Adolescent; Adult; Barotrauma - diagnostic imaging; Barotrauma - etiology; Breath Holding; Humans; Hyperventilation; Lung Injury - diagnostic imaging; Lung Injury - etiology; Male; Mediastinal Emphysema - diagnostic imaging; Mediastinal Emphysema - etiology; Neck; Radiography; Remission, Spontaneous; Subcutaneous Emphysema - etiology; Breath-hold diving; freediving; buccal pumping; pulmonary barotrauma; case reports; arterial gas embolism; cerebral arterial gas embolism (CAGE)
• ISSN: 1833-3516

Normally pulmonary over-inflation is not an issue during breath-hold diving, in contrast to lung squeeze. Compared with compressed air diving, pulmonary barotrauma is rare in breath-hold diving. Several mechanisms can lead to an increase in intrathoracic pressure in breath-hold diving that may cause alveolar rupture. Here we report three cases of pulmonary barotrauma in breath-hold diving. Using high-resolution chest tomography, bullous damage in Case 1, and pneumomediastinum in Cases 2 and 3 were detected. Transient neurological symptoms in Cases 1 and 2 suggested cerebral arterial gas embolism. The mechanisms that caused intrapulmonary overpressure were, respectively, lung packing ('buccal pumping'), considerable effort and straining at depth, and breathing compressed air at depth and ascending without exhaling. All three cases recovered without specific treatment such as recompression.