Advice on possible DCI hit

[duke dive medicine]

Sensitivity for a cxr catching a pneumothorax, especially a small one, isn’t that good at all.

“The pooled sensitivity of CXR was 45.65% (36.04%-55.26%), and pooled specificity was 99.62% (99.00%-100%).”

https://journals.sagepub.com/doi/abs/10.1177/0885066620987813?journalCode=jica#:~:text=Numerous%20studies%20and%20meta%2Danalyses,62%25)%20in%20identifying%20pneumothoraces.

In the ER if I’m truly concerned for a pneumothorax bedside ultrasound or a CT scan is our go to. Yes we will often get the cxr because they’re quick, easy, and cheap, but if I truly concerned for a small pnuemo I won’t hang my diagnosis (or lack there of) on a 2V CXR.

Thanks for the data backup! An amount of air large enough to lead to the OP's symptoms would (hopefully) have been caught, but I've seen clinically significant pneumos missed on x-ray as you likely have too.

Best regards,
DDM

 

[Imla]

Food for thought: When exhaling AND inhaling, your airways are open. So even though you inhaled while ascending, your airways were obviously open and it would be quite challenging to increase pressure in the lungs to harmful levels. If you were inhaling, you were creating an negative pressure grading to actually get air into the lungs. If they were full, air would not enter.
Continuous breathing even on a fast ascent is not the challenge. The challenge is usually for those who hold their breath if they are stressed or tensed up.

 

[kinoons]

Thanks for the data backup! An amount of air large enough to lead to the OP's symptoms would (hopefully) have been caught, but I've seen clinically significant pneumos missed on x-ray as you likely have too.

Best regards,
DDM

You would think that symptoms vs severity go hand in hand, but not always.

Purely an observation, but I’ve seen huge pneumo’s in peeps who are just sitting here chilling and some tiny ones in folks you’d sware are going to die right in front of you they’re in such pain and distress.


So in general I agree with the notion that if it hurts that bad you’d think something bad is going on, but that’s not always the case. Although I’ve never seen any study linking severity of symptoms to severity of the pneumothorax.

And I’ve absolutely seen a clinically significant pneumothorax missed on a 2v

 

[Juliet of the Sea]

Thanks for both replies, firstly, I was not diving at work when this happened so doesn’t involve DWR. Simply diving recreationally.

@Dukedivemedicine
Dive profile was relatively square give or take 1m depth from the 13m, not a yo-yo dive as some may call it. As mentioned was fun diving, looking for lobsters etc under boulders. Nothing strenuous.
Equipment consist of Scuba 15L cylinder on air, 3L pony and BCD. At end of dive I inflated my DSMB, which somehow became entangled with my drysuit inflation hose and with the time it took to try to untangle/cut this I was already at 4M and flying up rapidly. There was no point in fighting it at this stage.
It is a reminder to me no matter how experienced you think you are things can go south very very quickly…
The main question I have in this scenario is whether you think, given the mild intermittent pain symptoms in their location, it’s possible to have minor lung barotrauma from this. Another doctor thought it unlikely, however it’s good to get a 2nd opinion.

Many thanks

In my opinion, this could well be lung baratrauma from ascending quickly. A small pneumthorax or pneumomediastinum is easily missed on a CXR. A Chest CT will often show a small air pocket that can't be seen on an x-ray. Is the pain related to breathing? Does it hurt more when you breathe in and out? If constant and not effected by breathing a lung cause is less likely.