Lung Cyst

[stuartXe]

I am a 33 years old male with a 2.5cm aerated cyst in my lung. The cyst is not visible on X-rays and was diagnosed by chance when I was a teenager (seems it’s congenital – from birth); a few years ago I took a CT Scan and the cyst has not changed in all those years.

I have been diving regularly since childhood, freediving to depths of 20m on a regular basis and scuba diving less frequently (2/10 times/year), with max dives down to 45m, although most in the 20/30m range, so I have “pressure tested” it before. I have however been advised that this cyst may pose a risk of pneumotorax in the event that the cyst is unable to “deflate” due to mucus or else during the acent, but on the other hand I have been told my cyst seems to have a thick layer, and to be clear inside, which may indicate good ventilation.

I have also been told that it could be removed, but the procedure to remove it would itself likely generate some new defects in the lungs as the insertion of anything in the lungs would typically do that. The doctor’s conclusion was that having a lung cyst is not an uncommon thing, that the majority of people who have them don’t realize even through X-Rays, and removing it would be comparable to cosmetic surgery. This logically means many divers have lung cysts like mine but are not aware of it, even if they get a “fit to dive” certificate. The doctor is not a dive medicine specialist so his advice was simply that I should avoid diving.

I assume that this is classified as a ‘pre-condition’ for DAN protection and if so I would need to obtain a “Fit to Dive” Certificate; given that my cyst is not visible from an x-ray, it would only be a pre-condition because whilst being something many divers may have, I am aware of it. This awareness raises several questions and I would like to seek some advice:

1. Common sense (and most doctors will say) that anything like a cyst increases diving risks, but I have found it very hard to get a real sense of how much more risk my condition poses, given that many people seem not to have those cysts and dive happily all their lives;
2. I’ll be looking for a doctor as I think this represents a “pre-condition” so to get DAN cover I’d need to a “fit to dive” certificate, any recommendations in Hong Kong and surrounding areas are welcome.

I’ll be in Lombok in a few weeks and will do some diving, as I’ve been doing all my life, but my strong interest in diving has long been constrained by this “potential risk”, so any helpful comments are welcome.

I realize a forum is not the right place to form a conclusive view on medical conditions, but I’d be glad to connect with other divers in a similar position, or hear any experience/views anyone has to share.

Thanks in advance

 

[Duke Dive Medicine]

Stuart,

The conservative advice would be to refrain from diving until you've been examined by a diving physician. At the moment you simply don't know what your risk of lung injury is, and at the risk of being presumptuous, I don't think anyone here can tell you. I'd also caution you against deriving false confidence in the fact that you haven't yet been injured. DAN Asia-Pacific may be able to recommend a diving physician in Hong Kong for you.

Best regards,
DDM

 

[DocVikingo]

Hi stuartXe,

Given a history of an air-filled congenital cyst of the lung that: (1) is quite small; (2) is thick walled & clear inside; (3) has always been asymptomatic; (4) per imaging has not changed in the slightest over decades; and (5) has since childhood been repeatedly subjected to the factors inherent to recreational free & scuba diving without any issues, IMHO it indeed does appear prudent to seriously consider the risks posed by having it excised solely for the purpose of increased psychological comfort.

That said, I fully concur with DDM that a consult with a dive savvy pulmonary medicine specialist would be very wise. Despite a number of positive prognostic factors, the risk of rupture still is more than zero. Exactly how much greater will remain unknown even after additional work up.

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.