Cerebral arterial gas embolism

Abstract

Introduction: Pulmonary barotrauma arises from excessive changes in pressure affecting the lungs. This is widely known among the diving fraternity as “burst lungs”. It is a clinical manifestation of Boyle’s Law acting upon the effects of a burst lung. The clinical effects of pulmonary barotrauma such as pulmonary tissue damage, pneumothorax, surgical emphysema and cerebral arterial gas embolism (CAGE) are often serious and potentially life-threatening. Among recreational divers, CAGE is the commonest cause of death, which is often attributed to drowning. Leitch et al1 reported an incidence of CAGE of 7 per 100,000 dives in a group of military divers. In the same study, CAGE was responsible for 31% of the diving accidents. Although with proper training and equipment the incidence is small, there is still a real risk in cases of panic surfacing, chronic smokers and those with a history of lung disease and previous pneumothorax. The various forms of pulmonary barotrauma are shown in Figure 1.