Response

Abstract

We would like to thank Drs Tetzlaff and Eichhorn for their useful comment on our study. 1 We agree with the authors that, based on literature, divers with bullae and blebs in the lungs have a potential risk on pulmonary barotrauma and subsequent cerebral air embolism. As mentioned in our study, there is a lack of information on the incidence of bullae and blebs in the healthy population, and performing prospective trials on this topic is indeed unethical. Most case reports or case series of divers with pulmonary barotrauma and a CT of the thorax showing abnormalities such as bullae, blebs, or air trapping suggest a causal relationship between these lung abnormalities and pulmonary barotrauma. Two arguments can be posed to refute that causality. First, when no CT scans are available from the patients before the accident, it cannot be ruled out that these abnormalities are actually the result of the barotrauma in these divers. Second, because we found an incidence of small bullae and/or blebs in one-third of the general population without underlying lung disease, 1 it can be expected that these abnormalities are also found in a large number of divers that suffered pulmonary barotrauma, not necessarily being the cause or lead point of the pneumothorax.

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