A Case of Pulmonary Decompression Sickness Presenting as Noncardiogenic Pulmonary Edema and Documented Venous Air Embolism

ABSTRACT

Pulmonary decompression sickness (DCS) is a relatively uncommon form of type II DCS, with a frequency of only 2.4% as averaged from several studies. The deposition of venous gas emboli in the pulmonary arterial circulation produces progressive dyspnea, cough, chest pain and the physical findings of increased central venous pressure and pulmonary arterial pressure, and right-sided strain on an electrocardiogram. We recently experienced a case of pulmonary DCS presenting as interstitial pulmonary edema combined with low central venous pressure. In this case, air bubbles that were trapped in the most nondependent part of the femoral vein were discovered incidentally, on abdominal computed tomography scan, which may mean that the buoyancy of gas bubbles was sufficient to counteract the venous blood flow propelling such bubbles in the direction of blood flow. In addition, we discuss the current availability of recompression facilities in South Korea since some difficulties are anticipated in treating an unstable patient with a monoplace hyperbaric chamber, which is typically the only available type of hyperbaric chamber in South Korea.