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Fitness to dive should rest on a clear CT chest scan

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Professional divers should have a computed tomographic (CT) examination during their initial medical for certification to exclude conditions that can lead to fatal lung damage during diving. This is especially important if they smoke or have had chest infections, as one case series from Turkey has shown.

The three male divers were aged between 25 and 56 years with 6 months’ to15 years’ diving experience. Two were regular long term smokers, smoking 20 cigarettes/day for 20 years and 23–30 cigarettes/day for 10 years, respectively. Symptoms occurred during ascent from a dive and included chest pain, breathing difficulties, and—in two instances—neurological symptoms. All divers recovered eventually with treatment, but all were excluded from diving.

CT scans of the chest showed air cysts or bullae predisposing to pulmonary barotrauma that were simply not evident in plain chest x ray films for each diver. In one case a large apical bulla was present; in another an azygous lobe on the right side and many air cysts in both lungs; and in the third a small bleb in the upper right lung.

Smoking and lung infections increase the risk of air sacs or bullae developing in the lung. These in turn increase the risk of pulmonary barotrauma, a complication of which—arterial gas embolism—caused almost a third of deaths from diving, according to one study.