[abstract] Subcutaneous Emphysema During 400 MSW Saturation Diving

Abstract

The subcutaneous emphysema is one of decompression sickness. We will report a case of emphysema which were extended to mediastinum and retro-pharyngeal space. A 25 year-old man who had been engaged in 400 msw saturation diving. The chief complaint was swelling of right shoulder skin and crepitus on palpitation at 5.5 msw on last day. The saturation diving was proceeded for 32 days. Physical examinations were performed just after diving. The subcutaneous emphysema were shown at the root of neck, supraclavicular fossa, mediastinum, retro-pharyngeal space by chest X-ray. Carotid space emphysema and lung bulla was detected by computed tomography (CT). An arterial gas analysis was as followed; pH = 7.405, PaO2 (102.9 mmHg), PaCO2 (38.3 mmHg), HCO3 (23.9 mEq/l), BE (0.1), O2Sat (97.7percent). There were not any complaints and symptoms such as cough, sore throat, hoarseness and dysphagia. The patient was diagnosed as serious emphysema, and treated with bed rest for 5 days. Patient was recovered well. Conclusions: There is a few case such as this patient in our saturation diving programs. The subcutaneous emphysema may become apparent, and include many symptoms. However, in this case patient had not manifest symptoms such as dyspnea or dysphagia. The characteristic of this case was sudden occurrence of emphysema, and the cause of this was considered by lung bulla ruptured.