Bulla ( bouble in the lung)

[vloupov]

Hello ,

I recently got the following problem with my daughter ( 26) :

" CT scan of the lungs:
There are no pathological findings in the mediastinum. Airways, heart and pulmonary vessels appear normal. Pleural adhesions and a certain extent of fibrosis in the upper lobes of the lungs are present. There is also a solitaire bulla in the upper lobe of the left lung. "

She is AOWD and the question is : is that finding critical for her diving and does it bring some additional hazard.
Unfortunately the MDs which treated her are not competent in diving medicine and are unwilling to take a firm position.

Any advice will be welcomed. Thank you in advance!

 

[TSandM]

It almost certainly brings additional hazard. Bullae are like blisters; they are large airspaces with thin walls, and are a risk factor for rupture and pneumothorax. The presence of a bulla (they don't say how large it is) combined with upper lobe fibrotic changes suggests a destructive process going on in the lungs. This is the type of thing we see in much older patients who are long-term smokers and have emphysema, but you can see these sorts of things with younger patients with certain autoimmune or genetic conditions (alpha 1 antitrypsin deficiency, for example).

I personally would not sign off on a clearance to dive for someone who had the CT scan described. I can't tell you statistically what the risk of a pneumothorax is for your daughter, but it is certainly significantly higher than the general population. And a pneumothorax at depth could easily prove lethal.

 

[vloupov]

Dear TSandM,
Thank you very much for your quick response!
And sorry for my ignorance in the translation of the CT description!

The Bullae is approx. 1cm .
My daughter have never smoked.

 

[DocVikingo]

Hi vloupov,

Ditto TSandM's concern.

Such pulmonary bullae can be congenital or the result of pulmonary disease. The CT reading of "Pleural adhesions and a certain extent of fibrosis in the upper lobes of the lungs are present" suggests a disease process of some type. However, in either case diving at this point would be contraindicated.

There are several often successful techniques for the repair of such air spaces. However, even if such repair were to be done diving still would be precluded until high resolution CT of the lungs, pulmonary functioning testing and other lung assessment proved without findings worrisome to SCUBA.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such. Consult with your physician before diving.