<abstract xmlns="http://www.w3.org/1999/xhtml">

<p>Current medical guidelines and regulations do not require routine examinations for the right-to-left shunt at divers. We present the case of a Polish Navy Dive Medical Officer (DMO) who more than 20 years ago suffered from decompression ilness - bends accompanied by cutis marmorata, numbness in one limb and mild vertigo. After treatment in decompression chamber all symptoms entirely resolved. Since then, despite of continuing diving, he experienced no decompression ilness symptoms. Twenty years later, then 52 years-old, the DMO was admitted as a patient to the Neurology Department at the Gdańsk Naval Hospital due to episodes of transient ischemic attacks. Contrast-enhanced transcranial Doppler ultrasound and transesophageal echocardiography were performed and he was diagnosed with severe right-to-left shunt across a patent foramen ovale (PFO). Retrospectively analyzing incident of DCI he suffered 20 years earlier, we suppose that it may have been caused by paradoxical air embolism associated with the RLS across the PFO, which was not diagnosed at the time of this incident yet. We conclude that although the risk of severe neurological, cutaneous or vestibular forms of DCI is very low, in order to increase diving safety, it seems to be reasonable to develop standards for initial PFO screening in certain groups of divers - professional divers, military divers and medical diving personnel. Contrast-enhanced transcranial Doppler ultrasound seems to be useful in RLS screening in divers. Using multi-compartment chambers equipped with an entry lock should be preferred for safe recompression treatment of divers.</p>
</abstract>

Current medical guidelines and regulations do not require routine examinations for the right-to-left shunt at divers. We present the case of a Polish Navy Dive Medical Officer (DMO) who more than 20 years ago suffered from decompression ilness - bends accompanied by cutis marmorata, numbness in one limb and mild vertigo. After treatment in decompression chamber all symptoms entirely resolved. Since then, despite of continuing diving, he experienced no decompression ilness symptoms. Twenty years later, then 52 years-old, the DMO was admitted as a patient to the Neurology Department at the Gdańsk Naval Hospital due to episodes of transient ischemic attacks. Contrast-enhanced transcranial Doppler ultrasound and transesophageal echocardiography were performed and he was diagnosed with severe right-to-left shunt across a patent foramen ovale (PFO). Retrospectively analyzing incident of DCI he suffered 20 years earlier, we suppose that it may have been caused by paradoxical air embolism associated with the RLS across the PFO, which was not diagnosed at the time of this incident yet. We conclude that although the risk of severe neurological, cutaneous or vestibular forms of DCI is very low, in order to increase diving safety, it seems to be reasonable to develop standards for initial PFO screening in certain groups of divers - professional divers, military divers and medical diving personnel. Contrast-enhanced transcranial Doppler ultrasound seems to be useful in RLS screening in divers. Using multi-compartment chambers equipped with an entry lock should be preferred for safe recompression treatment of divers.

A Case of Decompression Sickness Associated With PFO in a Dive Medical Officer

Polish Hyperbaric Research

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

{"article-title":"A Case of Decompression Sickness Associated With PFO in a Dive Medical Officer"}

Current medical guidelines and regulations do not require routine examinations for the right-to-left shunt at divers. We present the case of a Polish Navy Dive...

A Case of Decompression Sickness Associated With PFO in a Dive Medical Officer

Publié en ligne: 15 oct. 2022

Pages: 15 - 24

Reçu: 12 janv. 2021

Accepté: 23 mars 2021

DOI: https://doi.org/10.2478/phr-2021-0008

Mots clés
decompression sickness, diving, paten foramen ovale, contrast Transcranial Doppler (cTCD), contrast-enhanced transthoracic echocardiography (cTEE), right – to – left shunt

© 2021 Krzysztof Dziewiatowski et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

A Case of Decompression Sickness Associated With PFO in a Dive Medical Officer

Publié en ligne: 15 oct. 2022

Pages: 15 - 24

Reçu: 12 janv. 2021

Accepté: 23 mars 2021

DOI: https://doi.org/10.2478/phr-2021-0008

Mots clésdecompression sickness, diving, paten foramen ovale, contrast Transcranial Doppler (cTCD), contrast-enhanced transthoracic echocardiography (cTEE), right – to – left shunt

© 2021 Krzysztof Dziewiatowski et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Mots clés
decompression sickness, diving, paten foramen ovale, contrast Transcranial Doppler (cTCD), contrast-enhanced transthoracic echocardiography (cTEE), right – to – left shunt