"punctured lung"

[beche de mer]

A hypothetical for any diving docs out there.

A guy rings you and says that he wants a dive medical but has been refused by a dive examiner elsewhere. He is 44 years old, fit and active, engaging in a variety of aquatic sports. At the age of 3 or 4 years, he had a "collapsed lung" or "punctured lung". The details are hazy. It was a long time ago. It appears that his lung condition occurred after being squeezed by grandma. He's not sure if there was a rib fracture and his mother can't remember. He now wants to dive.

Would you assess him as:

(a) Unfit under any circumstances?
(b) Fit if normal CXR?
(c) Fit if normal high resolution CT scan?
(d) Refer to respiratory physician specialising in dive medicine?

If you chose option (a), what is your rationale, if high resolution imaging is normal?

All opinions welcomed.

 

[TSandM]

I'm not an expert in hyperbaric medicine, but a traumatic pneumothorax at age 3 in a 44 year old guy with no further problems wouldn't make me worry at all about his lung structure. If there was anything else in the history to worry about (family history of pneumothorax, for example), I'd get the scan . . . no blebs, I'd relax about it.

 

[BigJetDriver]

As a DMT, if I were asked for an opinion, I would be concerned about the reason he was refused by one "dive examiner".

To clear up any possible concerns, I would recommend he get a high-res scan, and discuss the results with a physician experienced in Diving Medicine (Sometimes hard to find, I know!).

With the history presented, I would not be overly concerned with the outcome, i.e. would expect him to be cleared to dive.

 

[miguel sanz]

I would try get more details about the "collapsed lung" (can´t he get the history where he was attended)+ probably do the scan anyway (I don´t think it´s very common that grandmas produce neumotorax!)+ if posible check it with a respiratory diving doctor (?¿?).
The fact that he was refused doesn´t necessarily mean anything. If I would get a similar case I would not certify him, but send him to a medical diving center in my city, just to be sure.

 

[BigJetDriver]

Hi, Miguel,

Actually, I think that is what I was recommending, is it not?

Rob

 

[beche de mer]

Thanks for your replies.

To continue the hypothetical. Let's say there was no clear history of trauma and hospital records are not available. (>40 years ago.) So it may have been a spontaneous pneumothorax at the age of 4. (A little unusual.)

If the high res scan is clear, is there any reason to preclude compressed gas diving?

 

[Benthos]

This is a hard question to get at online with such limited information. Here are a few surface concepts though:


If the pneumo is caused by trauma that does not injure the viceral pleura around the lung or the lung itself then the likelyhood of future complications may be low. This individual may be able to return to recreational diving. However if the injury (lets say a broken rib) damages the lung, viceral or parietal pleura then then scar tissue formation may put the individual at increased risk for developing a spontainous pneumo or pulmonary complication in the future.

Now spontainous pneumo is a different ball game because the literature tell us that individuals who sustain a spontainous pneumothorax are at signifigant (p<0.05) risk of developing a spontainous pneumothroax and other pulmonary complications in the future. This is why Hx of spontainous pneumo is a direct contraindication to diving.

A number of immaging studies can (not will) illucidate pathologies that can place you at risk for spontainous pneumo. However if this person is trying to pass a diving physical then it is likely for some type of research or commercial work (NOAA/AAUS etc.). The DMO's for these organasations have a set criteria people must meet for medical clearance and any pneumo may simply be an immediate disqualifier under their auspices.

 

[Avic7]

Thank god for dictionaries. Had to look up so many words.

 

[miguel sanz]

Hard Case. Of Course The Scan Doesnt Rule Out Possible Problems That May Lead To Spontaneous Neumo. It&#180;s Hard To Tell Someone Not To Dive, Even More When You&#180;re Not Sure. If We Didn&#180;t Have Fear About Legal Aspect We Should Tell Him What We Think And Let Him Decide Asuming His Own Risks. In The Other Hand, There&#180;re Many Things One Can Do Other Than Diving (are They? )

 

[miguel sanz]

Oh! I Forgot, Yes Bigjet, We Were Saying About The Same