Reducing the Risks of Pulmonary Barotrauma
The same conditions that cause spontaneous
pneumothorax can be deadly in the increased ambient pressures
diving - and even in the pressure changes that take place in
aircraft. Awareness of these conditions that can lead to spontaneous
might aid in the reduction of the risk of 'burst lung' and cerebral
Some of these conditions
and diseases include:
mucoviscidosis (cystic fibrosis), Pneumocystis carinii, tb,
(smokers), viral lower airway disease, HIV infection, bronchial
sports blunt trauma, weight lifting, metastatic tumors, catamenia
empyema, bullous emphysema (juvenile, apical, generalized), Marfan's
syndrome, Schistosome infestation, Pregnancy, cryptogenic fibrosing
alveolitis, and pulmonary
X, Congenital bronchopulmonary cystic disease,
disease, alveolar proteinosis, bronchiectasis
Shortness of breath
Blue or pink discoloration of the nail beds
or lips (blue bloater or pink puffer)
Exposure to chemical or commercial agents
Audible wheezing and
(stethoscope findings by the physician)
Increased AP diameter
rounded and tips of fingers widened)
Nail bed and lip color
in the lung fields (tonal reverberations)
the best to rule out pulmonary blisters)
Vital Ca pacity
Awareness of cause of problem (ascending
from depth with a closed
Breath holding on ascent
'Sipping' from a regulator by a free diver
Weight lifting from depth
Boat exits in heavy wave action
-ascend anchor line for stability
-continue to breathe via regulator until you are out of
Straining while removal of gear (fins, weight belt) in the water
Poor air management, avoid running out of air
Faulty buddy breathing practices
References and abstracts for Spiral CT scan
Air trapping on expiratory high-resolution
CT scans in the absence of inspiratory scan
abnormalities: correlation with pulmonary
function tests and differential diagnosis.
Author Arakawa H; Webb WR
Address Department of Radiology, University of California, San
Source AJR Am J Roentgenol, 170(5):1349-53 1998 May
OBJECTIVE: We wish to describe the
diagnosis and pulmonary function
correlates of patients with normal findings
on inspiratory high-resolution CT (HRCT) scans
who showed air trapping on expiratory scans.
Air trapping on expiratory HRCT scans in patients with normal findings
on inspiratory scans is most often associated with bronchiolitis
and asthma. Obtaining expiratory scans in patients who may have one of
these diseases recommended.
Title Preoperative and postoperative imaging in the surgical
Slone RM; Gierada DS; Yusen RD
Mallinckrodt Institute of Radiology,
Hospital, Washington University School of
Medicine, St. Louis, Missouri, USA.
Radiol Clin North Am, 36(1):57-89 1998 Jan
For patients with emphysema, imaging studies
have been useful for diagnostic purposes and for
preoperative patient selection for surgical intervention, such as
and LVRS. Chest radiography is useful in evaluating hyperinflation.
Inspiratory and expiratory
films are used to estimate diaphragmatic excursion and air-trapping.
CT scan is used to evaluate the anatomy and distribution of emphysema
the lungs, providing information clinically unobtainable by other
Both imaging techniques are useful for detecting other disease
Radionuclide lung scanning also provides an estimate of target areas,
occupying but nonfunctioning lung. Cohort studies utilizing these
techniques have demonstrated associations between preoperative
and postoperative outcome. The imaging studies, especially the chest
have also played an important role in postoperative management. Many
imaging options are available, such as HRCT scan, quantitative CT scan,
and single photon emission CT scan. Other techniques, such as MR
may play a future role as well.
Title [Dynamic computed tomography in the study
Zompatori M; Poletti V; Battista G; Canini
R; Bruscoli P; Carfagnini F
Radiologia Padiglione Pneumonefrologico,
S. Orsola-Malpighi, Bologna.
Radiol Med (Torino), 94(4):308-14 1997 Oct
Obliterative or constrictive bronchiolitis
is characterized by narrowing of the small airways, due
to submucosal and peribronchiolar fibrosis, with chronic obstruction.
The vast majority of cases
of bronchiolitis obliterans are associated with other diseases and
only few cases are idiopathic.
We report on the main computed tomography (CT) methods used study
bronchiolitis, the CT findings and the differential diagnosis
with other diseases. The combination of HRCT, rapid volumetric
and advanced image display is a powerful tool study the normal and
features of bronchiolar function and alveolar ventilation.
Title Expiratory CT scans for chronic airway
correlation with pulmonary function test
Lucidarme O; Coche E; Cluzel P; Mourey-Gerosa
I; Howarth N; Grenier P
Department of Radiology, Universit´e
Pierre et Marie Curie, H^opital de la Piti´e-Salp^etri`ere,
AJR Am J Roentgenol, 170(2):301-7 1998 Feb
OBJECTIVE: The purpose of our study was to
correlate findings on expiratory CT scans with
results of pulmonary function tests (PFTs)
and to determine whether these techniques may be
complementary in assessing airway obstruction.
CONCLUSION: Air trapping may permit detection of airway obstruction
in patients with
clinically suspected chronic airway disease
even when PFTs are normal. Furthermore,
expiratory CT allows one to calculate a
score for a cross-sectional lung area that
appears to be better correlated with the
of airway obstruction measured on PFTs.
Air trapping in children: evaluation with
dynamic lung densitometry with spiral CT.
Johnson JL; Kramer SS; Mahboubi S
Department of Radiology, Children's Hospital
of Philadelphia, PA 19104, USA.
Radiology, 206(1):95-101 1998 Jan
PURPOSE: To evaluate the feasibility of the
use of a simple method of dynamic lung
densitometry with spiral computed tomography
(CT) to differentiate air trapping from
compensatory hyperinflation in children.
CONCLUSION: Dynamic spiral CT lung densitometry is a quick, simple
method for quantitative confirmation of the presence of air trapping
differentiation from compensatory hyperinflation.
[Quantitative assessment of pulmonary
with computerized tomography.
Comparison of the visual score and high
resolution computerized tomography, expiratory density mask with spiral
computerized tomography and respiratory function tests]
Zompatori M; Battaglia M; Rimondi MR; Fasano
L; Cavina M; Pacilli AM; Guerrieri A; Fabbri
M; Vivacqua D; Biscarini M
Radiologia padiglione Pneumonefro, Policlinico
S. Orsola-Malpighi, Bologna.
Radiol Med (Torino), 93(4):374-81 1997 Apr
CT is the most accurate method to detect
emphysema in vivo.
Quantitative chest computed tomography
as a means of predicting exercise performance in
Crausman RS; Ferguson G; Irvin CG; Make B;
Newell JD Jr
Department of Medicine, National Jewish Center
for Immunology and Respiratory Medicine,
Denver, CO 80206, USA.
Acad Radiol, 2(6):463-9 1995 Jun
RATIONALE AND OBJECTIVES: We assessed the
value of quantitative high-resolution
computed tomography (CT) as a diagnostic and
prognostic tool in smoking-related emphysema.
Quantitative chest CT assessment
of disease severity is correlated with the
degree of airflow limitation and exercise
impairment in pulmonary emphysema.
Spiral computed tomographic scanning of
the chest with three dimensional imaging in the diagnosis and
of paediatric intrathoracic airway obstruction.
Sagy M; Poustchi-Amin M; Nimkoff L; Silver
P; Shikowitz M; Leonidas JC
Division of Critical Care Medicine, Schneider
Children's Hospital, Long Island Jewish Medical
Center, New Hyde Park, NY 11042, USA.
Thorax, 51(10):1005-9 1996 Oct
BACKGROUND: The usefulness of spiral computed
tomographic (CT) scans of the chest
with three dimensional imaging (3D-CT) of
intrathoracic structures in the diagnosis and
management of paediatric intrathoracic airway
obstruction was assessed.
CONCLUSIONS: 3D-CT scanning is a useful additional diagnostic tool
intrathoracic airway obstruction in paediatric
Thin-section CT detection of emphysema
associated with bronchiectasis and correlation with
pulmonary function tests.
Loubeyre P; Paret M; Revel D; Wiesendanger
T; Brune J
Service de Radiologie, Hopital
et Pneumologique, Lyon, France.
Chest, 109(2):360-5 1996 Feb
PURPOSE: To evaluate, on thin-section CT
the prevalence of emphysema in patients
with bronchiectasis and to correlate the
of thin-section CT scans with the results of
pulmonary function tests, in order to question
whether there was a particular functional test
profile in this group of patients.
CONCLUSION: Our series suggests that there
is a high prevalence of emphysema in patients
with bronchiectasis. Emphysema that was not
suggested using pulmonary function tests in
most of the cases could explain in part the
higher airway obstruction observed in the group of
patients with CT evidence of emphysema. This
study could support the suggestive notion that
emphysema, which was mainly localized in
lobes, could be due to the
inflammatory airway process.
Airway obstruction in asthmatic and
individuals: inspiratory and expiratory thin-section
Park CS; M¨uller NL; Worthy SA; Kim JS;
Awadh N; Fitzgerald M
Department of Radiology, University of British
Columbia and Vancouver Hospital and Health
Sciences Centre, Canada.
Radiology, 203(2):361-7 1997 May
PURPOSE: To determine differences in computed
tomographic (CT) findings in asthmatic and
healthy individuals and to correlate the
with severity of airway obstruction.
Thin-section CT is of limited value in
asthmatic patients with normal airflow or
mild airflow obstruction from healthy
Radiology of pulmonary emphysema and lung
volume reduction surgery.
Slone RM; Gierada DS
Mallinckrodt Institute of Radiology,
University School of Medicine, St. Louis, MO
Semin Thorac Cardiovasc Surg, 8(1):61-82 1996
Lung volume reduction surgery (LVRS), which
involves the bilateral wedge resection of 20%
to 30% of the most diseased lung through a median sternotomy,
is emerging as a promising
treatment option for select patients with severe, debilitating
emphysema. This article details our
observations and preliminary investigations related to the imaging
evaluation of patients
including selection criteria, postoperative findings, and structural
changes in the thorax after surgery.
Quantification of pulmonary emphysema from
lung computed tomography images.
Uppaluri R; Mitsa T; Sonka M; Hoffman EA;
Department of Electrical and Computer
University of Iowa, Iowa City 52242,
Am J Respir Crit Care Med, 156(1):248-54 1997
A texture-based adaptive multiple feature
method (AMFM) for evaluating pulmonary
parenchyma from computed tomography (CT)
is described. Quantitative texture analysis using adaptive
multiple features holds promise for the
noninvasive evaluation of the pulmonary
Normal pulmonary geometric changes due
to respiration: evaluation with inspiratory and
expiratory spiral CT.
Wang Q; Takashima S; Sone S; Maruyama Y;
Department of Radiology, Shinshu University
School of Medicine, Matsumoto, Japan.
Radiat Med, 16(4):257-62 1998 Jul-Aug
RATIONALE AND OBJECTIVES: To investigate the
pattern of physiological pulmonary
geometric changes in the longitudinal
due to respiration. CONCLUSION: We have described the normal
displacement patterns of the pulmonary structures due to respiration.
findings may be applied to the diagnosis of pulmonary diseases.
[Spontaneous pneumothorax in young women:
Louis H; Los H; Lagendijk JH; de Graaff CS;
Afd. Interne Geneeskunde, Academisch
Vrije Universiteit, Amsterdam.
Ned Tijdschr Geneeskd, 141(40):1924-8 1997
(Recurrent) pneumothorax developed
in three women aged 33, 35 and 36 years, two of whom were pregnant.
consisted in drainage of the pneumothorax, pleurodesis and pleurectomy,
with administration of medroxy-progesterone. One year later, the
had not recurred.
[Usefulness of computed tomography and
scintigraphy in diagnosis of emphysematous bullae in the lung]
Furman M; Kozlowski M; Szulc S; Rogowski F;
Gulaj C; Bernacki A; Cybulski A
Kliniki Chirurgii Klatki Piersiowej,
Wiad Lek, 50(7-9):156-62 1997
The x-ray examinations usually do not reveal
morbid changes after lung expansion in the
treatment of spontaneous pneumothorax. In
our observation computed tomography (CT) and
scintigraphy enable not only the exact
of the extent of changes but also they
disclose bullae invisible in conventional
CONCLUSION: CT is a method of choice in the diagnosis of lung
and it enables the detection of the changes undetectable in
chest radiographs. Perfusion and inhalation scintigraphy is helpful in
the diagnosis of large emphysematous bullae and postoperative follow-up
Contribution of emphysema and small
Gelb AF; Hogg JC; M¨uller NL; Schein MJ;
Kuei J; Tashkin DP; Epstein JD; Kollin J; Green
RH; Zamel N; Elliott WM; Hadjiaghai L
Department of Medicine, Lakewood Regional
Medical Center, School of Medicine, CA, USA.
Chest, 109(2):353-9 1996 Feb
BACKGROUND: The contribution and role of
and small airways disease in
causing expiratory airflow limitation in COPD
is controversial. CONCLUSIONS: High-resolution CT lung scans are
an in vivo surrogate to quantitate moderate to severe morphologic
Emphysema does not appear to be primarily responsible for severe
airflow limitation in most patients with severe COPD. There was no
between severity of small airway histologic condition and emphysema or
FEV1 percent predicted. The causes of the lesions responsible for small
airways obstruction need to be identified.
[Detection of emphysematous bullae in
pneumothorax by three-dimensional computed topography]
Yusa T; Iyoda A
Department of Respiratory Surgery, Chiba Rosai
Nihon Kokyuki Gakkai Zasshi, 36(8):722-5 1998
The patient was a 20-year-old woman with
pneumothorax, who had had
pneumothorax twice on each side. This suggests
that three-dimensional CT is a useful method for diagnosing and
emphysematous bullae in patients with spontaneous pneumothorax.