I think the confusion is that as divers we associate AGE with a lung over expansion injury. However arterial gas embolism occurs when
gas bubbles enter or form in the arterial vasculature and occlude blood flow. A lung over expansion injury is not the only way that can occur.
AGE can occur from ruptured alveoli after lung barotrauma ( lung over expansion injury ). AGE can also occur via migration from the venous circulation (venous gas embolism) via a right-to-left shunt (PFO, ASD).
As divers we are taught that the 4 lung over expansion injuries are:
- Arterial gas embolism - AGE
- Pneumothorax
- Mediastinal Emphysema
- Subcutaneous Emphysema
No where is it stated that the
only way an AGE can occur is through a lung over-expansion injury.