Sudden Death in a Diver: A Diagnostic Conundrum

Abstract

We discuss the case of an experienced diver who ran out of air during his final ascent while scuba diving. He lost consciousness rapidly after surfacing and despite immediate cardiopulmonary resuscitation, could not be revived. On arrival at the emergency department he was noted to have copious amounts of blood in his upper airway and had developed extensive subcutaneous emphysema. Large amounts of air were observed in the central circulation following a postmortem computerized tomography scan as well as pneumomediastinum, a small right-sided hemothorax, and extensive subcutaneous emphysema. We discuss several potential pathophysiological mechanisms that might explain these findings. Finally, we end with a recommendation for an expedient whole-body postmortem computerized tomography scan and autopsy by a suitably qualified pathologist in the investigation of all dive-related fatalities, where possible.

Mediastinal emphysema after long‐distance flight with ketoacidosis and underlying diabetes mellitus type 1

“…Alveolar over‐inflation with subsequent alveolar over‐inflation and rupture with consecutive transfer of air along the bronchi into the mediastinum has been identified as primary mechanism . As such, increased intra‐alveolar pressure (relative to the interstitium surrounding peripheral alveoli), during coughing, vomiting, and cocaine sniffing, and barotrauma during diving or gas inhalation present characteristic triggers of SPM . Similarly, activities associated with alveolar over‐inflation such as pronounced physical activity have been associated with SPM .…”