Spontaneous Pneumothorax

[a64pilot]

Lets see, Tall = no, Skinny = no, Young = no. I guess I 'm in the clear too

[gasdiver]

For what it's worth, my friend is 40 something, short and stocky...

[JamesK]

Oh Crap...

Is there anything folks can do to lower the risk of this. Diving is very very important to my pursuit of happiness.

Mark (the tall skinny guy)

Get old and fat?

[scububa]

Are there any indicators, screens, etc.? Or is that what 'spontaneous' rules out?

[RN]

For what it's worth, my friend is 40 something, short and stocky...

Chest x-ray probably showed a bleb or 2 then. While spontaneous pneumo can be a common occurrence in tall, skinny teenagers, the incidence does decrease with age. The spont. pneumos that happen to that age group usually just happen. No cause is usually found. Those that occur outside of that age range, or body type, can usually be attributed to blebs. Either way no more diving.

[Webmaster]

I work with a guy that's 22, and he's had 4-5 I believe.

[MORGAN]

Years ago I was on a canoe trip in northern Canada. We were fishing from a gravel bar and one of the guys took off his shirt. I noticed some small scars on his chest and said, "Hey Bill, those look like chest tube scars."

"Yeah, my lungs have collapsed a few times - it just happens." Then he rolled a cigarette, took a big drag, and started to cough. He didn't smoke at home, but liked to smoke hand-rolled cigarettes on canoe trips.

As an ER nurse/paramedic I had a fairly comprehensive wilderness medical kit, but I was not looking forward to decompressing his chest. I consoled myself with the thought that spontaneous pneumothoraces usually progress slowly, we had a satellite phone, and the Canadian military has a very effective wilderness search & rescue service. Fortunately, we finished the trip with no problems except for the usual 100 black fly bites each.

[LCF]

As said, spontaneous pneumothorax is a well-known entity. It usually occurs as a result of some abnormality in the underlying lung, whether that is from congenital malformations (blebs) or acquired abnormalities as a result of smoking or other lung toxicities. However, it is possible to have a spontaneous pneumothorax as a result of, for example, a violent fit of coughing, if the pressure in the chest is raised high enough (just like expansion pneumothorax among divers). Spontaneous pneumothorax is not uncommon in cystic fibrosis patients.

Recurrences rates are high -- in some studies, as high as 50% within three years. This is the reason that spontaneous pneumothorax is considered one of the few absolute contraindications to scuba diving. Uncomplicated pneumothorax, in someone who has healthy lungs and a healthy heart, is usually no more than a nuisance. The patient may complain of some chest discomfort, cough, and poor exercise tolerance. But when the air in the chest begins to expand as one ascends from a dive, the physiology changes. Now, instead of a passively deflated lung, you have pressure in the chest pushing against the lung AND the heart and great vessels. The structures in the center of the chest can be pushed well off to one side -- and what happens then is that the veins bringing blood back to the heart get kinked, and blood return is impeded. This is a true, surgical emergency; without decompression of the chest, the patient will quickly die. As you can imagine, it would be a logistical nightmare to diagnose this underwater, let alone treat it effectively. Therefore, I think it isn't unfair to say that a spontaneous pneumothorax suffered at depth will be fatal. In general, if you have a significant risk of something which will almost certainly kill you if it happens when you dive, you are advised not to dive.

[OFG-1]

Get old and fat?

It's worked for me!

ps - I have a friend that had a lung collapse while he was on the can, too much cheese or something.

[debersole]

As said, spontaneous pneumothorax is a well-known entity. It usually occurs as a result of some abnormality in the underlying lung, whether that is from congenital malformations (blebs) or acquired abnormalities as a result of smoking or other lung toxicities. However, it is possible to have a spontaneous pneumothorax as a result of, for example, a violent fit of coughing, if the pressure in the chest is raised high enough (just like expansion pneumothorax among divers). Spontaneous pneumothorax is not uncommon in cystic fibrosis patients.

Recurrences rates are high -- in some studies, as high as 50% within three years. This is the reason that spontaneous pneumothorax is considered one of the few absolute contraindications to scuba diving. Uncomplicated pneumothorax, in someone who has healthy lungs and a healthy heart, is usually no more than a nuisance. The patient may complain of some chest discomfort, cough, and poor exercise tolerance. But when the air in the chest begins to expand as one ascends from a dive, the physiology changes. Now, instead of a passively deflated lung, you have pressure in the chest pushing against the lung AND the heart and great vessels. The structures in the center of the chest can be pushed well off to one side -- and what happens then is that the veins bringing blood back to the heart get kinked, and blood return is impeded. This is a true, surgical emergency; without decompression of the chest, the patient will quickly die. As you can imagine, it would be a logistical nightmare to diagnose this underwater, let alone treat it effectively. Therefore, I think it isn't unfair to say that a spontaneous pneumothorax suffered at depth will be fatal. In general, if you have a significant risk of something which will almost certainly kill you if it happens when you dive, you are advised not to dive.

I couldn't have said it better myself. This is why a history of spontaneous pneumothorax is one of the real "contraindications" for diving.

Doug