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Case 98


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A 28-year-old female patient, who was a deep-sea diver and worked as a scuba diving instructor, underwent breast augmentation and abdominoplasty¸ without perioperative complications. However, during postanesthetic recovery, she made a strong inspiratory effort, which was followed by acute respiratory failure and desaturation. A chest radiography was then performed.

Based on the clinical history and image provided, which is the most likely diagnosis?

a) Pulmonary barotrauma


b) Gas embolism


c) Nitrogen narcosis


d) Decompression syndrome



  • - Pulmonary barotrauma consists of the rupture of the alveolar membrane due to elevated transalveolar pressure.

  • - It may occur due to acute decompression during rising in deep-sea diving or in other situations in which there is augmentation of the intra-alveolar pressure, such as mechanic ventilation.

  • - Divers are more prone to pulmonary barotrauma due to the formation of bubbles, called bullae, on the surface of thoracic structures.

  • - The main consequences are: pneumothorax, pneumomediastinum, pneumopericardium, pulmonary interstitial emphysema and subcutaneous emphysema.

  • - Treatment consists of lowering airway pressure and specific case-related measures, such as thoracic drainage for hypertensive pneumothorax.


  • - RUSSI EW. Diving and the risk of barotrauma. Thorax 1998;53(Suppl 2):S20–S24.
    - PHATAK UA, DAVID EJ, KULKARNI PM. Decompression syndrome (Caisson disease) in a Indian diver. Annals of Indian Academy of Neurology. 2010;13:3;202-203.
    - GERMONPRÉ P, BALESTRA C, PIETERS T. Influence of scuba diving on asymptomatic isolated pulmonary bullae. Diving and Hyperbaric Medicine: The Journal of South Pacific Underwater Medical Society. 2008 Dec;38(4):206-11. 
    - Chandy, D, Weinhouse, GL. Complications of scuba diving. In: UpToDate, Danzl, DF (Ed), UpToDate, 2013.
    - O´Dowd, LC, Kelley, MA. Air embolism. In: UpToDate, Mandel, J (Ed), Uptodate, 2013.


Renato Gomes Campanati – 4th year medical student of UFMG School of Medicine. E-mail: campanati[at]

João Paulo Sampaio – 4th year medical student of UFMG School of Medicine. E-mail: jpmedufmg[at]


Paulo Roberto da Costa – Plastic surgeon and member of the Department of Complementary Propedeutics (UFMG School of Medicine). E-mail: pauloplastica59[at]


Emília Valle Santos, Marina Bernardes Leão and Professor Viviane Parisotto

Translated by

Renato Gomes Campanati - 4th year medical student at UFMG. E-mail: campanati[at]

Lucas Resende Lucinda - 6th year medical student of UFMG School of Medicine. E-mail: lucasresendebh[at]


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