Periorbital Emphysema After Dive Barotrauma Without Radiological Evidence of Paranasal Sinus Injury

Pennell, David John Laurie; Asimakopoulos, Panagiotis; Ram, Bhaskar; Veitch, Derek

doi:10.3357/asem.3990.2014

Cited by 10 publications

(4 citation statements)

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“…2,3 Other mechanisms include postsurgery, infection, forceful nose blowing, sneezing, weight lifting, bungee jumping and pressure changes during airplane travel or free diving, as a complication of sinus barotrauma. 4 To the best of our knowledge, there are only five previously reported cases of diving-related PE (Table 1). [4][5][6][7] All of these cases, except one that was not documented, were male.…”

Section: Discussionmentioning

confidence: 96%

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Periorbital emphysema after a wet chamber dive

2017

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Although periorbital emphysema (PE) is commonly associated with orbital fractures, it may develop without any fracture or significant trauma in circumstances such as post-surgery, infection, forceful nose blowing, sneezing, and weight lifting. We report on a healthy military diver who developed PE following a wet chamber dive. A diagnosis of PE secondary to sinus barotrauma was reached. He was treated conservatively without medication and his symptoms recovered completely within 10 days. To the best of our knowledge, only five cases of diving-related PE have been reported in the literature. Analysis of these cases and ours revealed that facial trauma, repeated forceful Valsalva manoeuvres and recent upper respiratory tract infection are probable risk factors for diving-related PE.

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Section: Discussionmentioning

confidence: 96%

“…4 To the best of our knowledge, there are only five previously reported cases of diving-related PE (Table 1). [4][5][6][7] All of these cases, except one that was not documented, were male. Images with radiography or CT showed no bony fracture.…”

Section: Discussionmentioning

confidence: 96%

Periorbital emphysema after a wet chamber dive

2017

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“…In a retrospective cohort of 306 divers, who were treated by otorhinolarnyngologists, 46 % had problems with the middle ear, 18 % with the inner ear, and 17 % with the nose and sinuses [29]. Sinus barotrauma from scuba diving is self-limiting in almost all cases, and frequently results from nasal pathology [30,31]. Two of the consultants argued, that as long as a normal outflow of gas from the paranasal sinuses is given, there should be no pressure gradient between this and the sella or the cranial cavity, which would allow diving even with incomplete bony closure after 3 months or 6 months, respectively.…”

Section: Divingmentioning

confidence: 99%

Consensus on Postoperative Recommendations After Transsphenoidal Surgery

Knappe

Moskopp

Gerlach

et al. 2018

Exp Clin Endocrinol Diabetes

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“…Typically, subcutaneous emphysema results from a lung injury—it therefore is most commonly found around the thorax, axillary and neck areas. Other aetiologies include post-laparoscopic1 or maxillofacial surgery,2 bowel perforation,3 facial bone fractures4 and even barotrauma associated with diving 5…”

Section: Introductionmentioning

confidence: 99%

Traumatic haemopneumothorax and ‘whole-body’ subcutaneous emphysema: successful use of a small-bore chest drain

et al. 2016

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A 56-year-old man presented having had two falls at home. He had a background of multiple sclerosis. After his second fall, during which he had fallen onto the toilet injuring his right chest, he was brought into the emergency department reporting pleuritic chest discomfort. Immediately evident was extensive swelling from his forehead to his thighs, which on palpation was found to be subcutaneous emphysema. A chest X-ray showed a large right-sided pneumothorax for which a chest drain was inserted. A CT revealed extensive surgical emphysema, pneumomediastinum, pneumoperitoneum and gas within the spinal canal. It also showed right-sided rib fractures and associated haemothorax. He was managed conservatively with a 12-French (F), small-bore, chest drain and made a complete recovery without complication. This case challenges the widely held, but poorly evidenced, opinion that traumatic haemopneumothorax needs to be managed with a large-bore surgical chest drain.

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Periorbital Emphysema After Dive Barotrauma Without Radiological Evidence of Paranasal Sinus Injury

Abstract: The authors recommend that a high index of suspicion for paranasal sinus barotrauma should be maintained in all patients reporting minor symptoms after diving (even to shallow depths) to facilitate rapid clinical diagnosis and prompt medical management.

Cited by 10 publications

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Periorbital emphysema after a wet chamber dive

Periorbital emphysema after a wet chamber dive

Consensus on Postoperative Recommendations After Transsphenoidal Surgery

Traumatic haemopneumothorax and ‘whole-body’ subcutaneous emphysema: successful use of a small-bore chest drain

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