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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

25%

b) Gas embolism

25%

c) Nitrogen narcosis

25%

d) Decompression syndrome

25%
   

Comments

  • - 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.

References

  • - 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.

Authors

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

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

Supervisor

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

Reviewers

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]ufmg.br

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

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