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Diving Hyperb Med. 2013 Dec;43(4):232-5.

Pneumomediastinum or lung damage in breath-hold divers from different mechanisms: a report of three cases.

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Director, Department of Underwater and Hyperbaric Medicine, Istanbul University, ─░stanbul Faculty of Medicine, 34093, Fatih/Istanbul, Turkey, Phone: +90-(0)532-412-5168, Fax: +90-(0)212-414-2032, E-mail:
Lecturer at the Department of Pulmonary Diseases, Istanbul, University, Istanbul Faculty of Medicine, Istanbul.
Resident at the Departments of Underwater and Hyperbaric Medicine.


Normally pulmonary over-inflation is not an issue during breath-hold diving, in contrast to lung squeeze. Compared with compressed air diving, pulmonary barotrauma is rare in breath-hold diving. Several mechanisms can lead to an increase in intrathoracic pressure in breath-hold diving that may cause alveolar rupture. Here we report three cases of pulmonary barotrauma in breath-hold diving. Using high-resolution chest tomography, bullous damage in Case 1, and pneumomediastinum in Cases 2 and 3 were detected. Transient neurological symptoms in Cases 1 and 2 suggested cerebral arterial gas embolism. The mechanisms that caused intrapulmonary overpressure were, respectively, lung packing ('buccal pumping'), considerable effort and straining at depth, and breathing compressed air at depth and ascending without exhaling. All three cases recovered without specific treatment such as recompression.


Breath-hold diving; arterial gas embolism; buccal pumping; case reports; cerebral arterial gas embolism (CAGE); freediving; pulmonary barotrauma

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