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Should computed chest tomography be recommended in the medical certification of professional divers? A report of three cases with pulmonary air cysts
  1. A S Toklu1,
  2. E Kiyan2,
  3. S Aktas1,
  4. M Cimsit1
  1. 1Istanbul University, Istanbul Faculty of Medicine, Department of Underwater and Hyperbaric Medicine, Istanbul, Turkey
  2. 2Istanbul University, Istanbul Faculty of Medicine, Department of Respiratory Disease, Istanbul, Turkey
  1. Correspondence to:
 Dr A S Toklu, Deniz ve Sualti Hekimligi AD, Istanbul Tip Fakultesi, Capa Istanbul 34390, Turkey; 
 akin{at}toklu.net

Abstract

Pulmonary barotrauma (PBT) is a recognised risk of compressed gas diving. Any reason that causes air trapping in the lung during ascent may cause PBT by increasing intrapulmonary pressure. Chest x ray examination is mandatory for medical certification of the professional divers in many countries, but pulmonary air trapping lesions such as an air cyst in the lungs cannot always be detected by plain chest x ray examination. Computed tomography (CT) is a reliable, but expensive measure for detecting pulmonary abnormalities in divers. Three cases with pulmonary air cysts are reported in which air cysts were invisible on the x ray pictures, but well defined by CT. It is impractical and not cost effective to perform CT for medical certification of all divers, but it can be an option to recommend CT once during the initial examination of the candidates for professional diving, especially if there is a history of predisposing factors, such as smoking or pulmonary infections.

  • air cyst
  • computed tomography
  • diving
  • professional diver
  • pulmonary barotrauma
  • AGE, arterial gas embolism
  • ATA, atmospheres absolute
  • CT, computed tomography
  • DCS, doubtful decompression sickness
  • HRCT, high resolution computed tomography
  • PBT, pulmonary barotrauma
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