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Sarcoidosis of the Lungs

Sarcoidosis is a disease that causes inflammation of the body's tissues. Inflammation is a basic response of the body to injury and usually causes reddened skin, warmth, swelling, and pain. Inflammation from sarcoidosis is different. In sarcoidosis, the inflammation produces small lumps (also called nodules or granulomas) in the tissues.

Unfortunately, sarcoidosis of the lungs causes granulomas that can obstruct the smaller airways (air trapping). This places the diver with this condition at risk for pulmonary barotrauma ('burst lung') when diving with compressed air. On ascent, you might develop gas embolism or pneumothorax (lung collapse) and possible death from drowning or cerebral damage from bubbles in the arterial circulation.

Question:
Dear Scubadoc:
My wife has been diving two years and has recently been diagnosed with sarcoidosis. This was based on a CXR and liver biopsy. Elevated LFT's prompted the studies. At this point she is asymptomatic. Could this be considered a relative contraindication to diving? Even with her current pulmonary involvement she uses far less air than I per dive and would like to keep diving. However we
do not want to do anything which would accelerate her disease process.
Thank you.

Answer:
It's not a matter of how much air she uses but the definite risk of having pulmonary barotrauma from 'burst' lung due to air-trapping. This risk is quantified by the degree of abnormality found in your lungs. This would be from the effects of Boyle's Law on ascending from a compressed air dive. Sarcoidosis causes significant pleural reaction and adhesions with the production of air-trapping. This air-trapping does not allow for the proper release of expanding air upon ascent from a dive - thus causing 'burst' lung. This can result in several things: pneumothorax, pneumomediastinum, subcutaneous emphysema and gas embolism with air bubbles getting into the arterial circulation and causing a stroke-like picture.

It would be my feeling that your wife should cease her diving activities until she gets some definitive advice from her pulmonologist as to the possible dangers that she is facing. Spiral CT scan of the lungs is sometimes helpful in dewlineating these problems.

Pulmonary Barotrauma from Sarcoidosis in a Chamber Dive
Here is a report of an accident that occurred in a recompression chamber (dry dive) and reported in the journal of Aviat Space Environ Med 1999; 70:594-7.

"An asymptomatic 46-yr-old male sustained an acute neurologic insult, appearing during the decompression phase of a 50-m dry hyperbaric chamber dive. The right hemisyndrome was most probably related to diving, since symptoms responded rapidly to the early commenced recompression therapy. Further diagnostics revealed a previously unknown pulmonary sarcoidosis with bilateral pulmonary opacities and pleural adhesions that might have predisposed to arterial gas embolism secondary to pulmonary barotrauma. This case may illustrate a potential risk of decompression illness even during dry chamber dives in patients suffering from asymptomatic pleuro-parenchymal pulmonary disease. The value of chest X-ray in the medical assessment of fitness to dive is therefore emphasized. "

Abnormalities of pulmonary sarcoidosis are present in 90-95% of the cases and remission (regression of symptoms and physical findings) occurs in about two thirds of the cases of sarcoidosis with pulmonary disease. Follow-up chest x-rays that show remission of the disease probably can allow return to diving after full respiratory assessment and one year of remission without recurrence of the disease. (in 'The Sports Diving Medical', by John Parker, MD)

For more information you may want to visit our web page at http://scuba-doc.com/pulprbs.html

References
Air trapping Medline References




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