Has anyone been diving after a collapsed lung?

[Sloeber]

Brief recap:

I recently suffered an accident in which I crashed my bicycle. Besides breaking my collar bone and tearing my AC joint, I also broke 5 ribs, one of which punctured my lung and collapsed it to 80%.

I'm 8 weeks past the initial injury and my lung has regained full volume to 100% and my body absorbed the 20%.

I have been in contact with DAN and briefly discussed this with them. They provided me with the following medical diagnosis taken from “Diving Medicine” by Alfred Bove (with notes added by me). In it he states the following regarding my injury:

“ Traumatic pneumothoraces caused by isolated injury to the chest wall should not pose any risk to the diver (so far so good, right?); however (uh-oh, I hate “howevers” in medical journals), most traumatic pneumothoraces are associated with underlying lung injury as well (mine was obviously – the 5 broken ribs). If the injury was severe enough to lead to radiographic changes (mine was – broken ribs and partially collapsed lung), it could have led to areas of air trapping (it did, about 20%, which has been slowly absorbed by the body and my lung is once again theoretically inflated to 100%). As a result, many authorities think that such persons should be advised not to dive (oh ****), although extensive diagnostic and hyperbaric chamber testing might define those at greatest risk.”

Let’s cut to the chase. It basically says the following: You should be able to dive again, but many authorities say you shouldn’t.

Hrmmm, OK…. OK? Talk about sitting on the fence with a medical diagnosis, eh?

My understanding is that at the 6 month mark I should submit myself to a spiral CT scan which will yield a much more detailed image of the injury than a traditional CT scan does. I'm told that not all lung injuries or lacerations heal, so this is of major concern to make sure mine actually healed. Next concern would be the amount of scar tissue from the healed laceration. Finally, if the spiral CT scan looks good, I should submit myself to a series of hyperbaric chamber rides to see how my lung reacts to the pressure.

So, I guess my question is, has anybody been through this before and can offer me some heads up on whats to come? Maybe offer me a ray of hope that my diving life has not prematurely ended. Or perhaps offer more insight or a different view point on the medical diagnosis of things?

TIA

 

[TSandM]

I'm actually somewhat surprised at the pessimistic attitude of a number of on-line articles I was able to find on this subject -- all of which were opinion pieces, and none of which contained citations of any literature to support the opinions voiced.

I did a MedLine search on traumatic pneumothorax and diving, and came up empty-handed; the same with the Rubicon Research Repository. I was unable to come up with ANY literature to support the idea that there is an unacceptably high risk of gas embolism in a patient with an uncomplicated traumatic pneumothorax. Now, admittedly, some patients with pneumothorax also have pulmonary contusions or ARDS or other problems that could lead to significant and worrisome pulmonary scarring. But the majority of healthy patients with uncomplicated traumatic pneumothorax recover fully.

A spiral CT scan is NOT a bad idea, given the serious sequelae of AGE. But I would be optimistic that it will show no significant pathology, and that you should be able to return to diving.

 

[Scott L]

Deleted

 

[netmage]

All the reading I've done seems to list spontaneous as the absolute contraindication.... as the potential of it happening again at depth would kinda suck....

Trauma induced however seems to indicate a greater level of risk as opposed to it have never happened to begin with.

All too often, in diving medicine, we simply don't know enough to say much with certainty... I know - been there, done that, and still diving...

-Tim

 

[DocVikingo]

Hi Sloeber,

The primary theoretical concerns in diving after traumatic pneumothorax are increased risk of arterial gas embolism (AGE) and tension pneumothorax, both of which can be quite serious. As such, given a pneumothorax secondary to puncture by a broken rib, some degree of conservatism arguably is warranted.

However, professional opinion is not all negative. For example:

“Cheng J, Diamond M.
SCUBA diving for individuals with disabilities.
Am J Phys Med Rehabil. 2005 May;84(5):369-75. Review.
SCUBA diving for individuals with disabilities. [Am J Phys Med Rehabil. 2005] - PubMed result

….”Pneumothorax can be spontaneous or result from trauma. Spontaneous pneumothorax can be associated with structural abnormalities and lung disease (21). It is a strict contraindication for SCUBA diving because the underlying cause may still be present at the time of diving (20). Many individuals who have disabilities resulting from traumatic events have had pneumothoraces. Traumatic pneumothorax, however, is not a contraindication provided that the injury is well healed.”

IMHO, a helical CT of the lungs is a very good idea, and you might wish to consider pulmonary function testing as well. As for “a series of hyperbaric chamber rides to see how my lung reacts to the pressure,” if I were the affected diver I personally would not go this far, but it might provide an extra layer of protection.

You may want to sort out up front which of these techniques are covered by your health care and which will be out of pocket. The chamber rides almost certainly will be your responsibility.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such. Consult with your physician before diving.

 

[tereza_chaul]

I am not doctor. I only wanna tell my story.
Ten months ago I went to Munich to Oktoberfest. I had just arrived at the airport and by missatention or jet lag I fell on the train rails. As a result: 2 broken ribs and a collapsed lung.
I stayed 6 days in hospital having chest drainage and was released.
Scince the fist minute my main concern was if I would ever dive again. From each doctor I had a different answer: "You can dive within a month" "You can dive within three months" "You can dive immediately" "You should wait six months" "You can never dive again".

Well, luckly I've found a good dive doctor in Brasil (though our dive infrastructure is not well developed, we have very good professionals). Four months after the accident I had a thoracic CT and the doc said I wasn't fit to dive yet, due to a bad recover of the broken rib. I had to wait five months till the second CT, and was finally declared fit to dive.

Yesterday, I had my first dive after ten months and evrything is fine.

 

[char.b]

9 years ago I had an operation on my spine which required having one lung deflated. I made a fully recovery from surgery and am active and healthy. I dived in Byron Bay Australia in March this year and everything was fine. However, Now that I want to learn to dive I am finding it very difficult to get a dive medical done in Australia. I have heard they are particularly strict here, but information online is just a negative and confusing. Despite not suffering from a spontaneous collapsed lung they still won't pass me.

Any information as to who I could speak to or dive doctors who could help would be greatly appreciated!

 

[DocVikingo]

Hi char.b,

Yes, the OZ medical standards relating to diving (Australian Standards AS 4005.1) are among the strictest in the world. And to get certified you must be signed off.

Perhaps you might wish to consider a second opinion. If you'll specify where in OZ you're residing, I can help you locate an approved diving medicine physician.

Regards,

DocVikingo

 

[marinediva]

Hi char,
if you are doing recreational diving in Australia all you need is the medical cert from a doctor qualified to give them.
If you are working as a professional in australia then the exam is harder and involves a chest xray.

 

[lulubelle]

Scince the fist minute my main concern was if I would ever dive again. From each doctor I had a different answer: "You can dive within a month" "You can dive within three months" "You can dive immediately" "You should wait six months" "You can never dive again".

Well, luckly I've found a good dive doctor in Brasil (though our dive infrastructure is not well developed, we have very good professionals). Four months after the accident I had a thoracic CT and the doc said I wasn't fit to dive yet, due to a bad recover of the broken rib. I had to wait five months till the second CT, and was finally declared fit to dive.

Yesterday, I had my first dive after ten months and evrything is fine.

I so wish that doctors would carefully seek the right information before rendering an opinion which going to impact something very important to us. Good for you for following up appropriately and waiting until your injury was healed.

I had a similar situation with the medical responses regarding diving after a very serious illness which included atelectasis of both lower lobes of my lungs and moderate heart failure, both of which were induced by my treatment and fluid overload, not by underlying Cardiopulmonary disease or injury. I recovered fully, and my illness was not relevant to diving in the long term, but still, the first dive doctor went completely contrary to DAN guidance on a couple of other issues and told me I should stop diving or dive in a very restricted manner. The next one went step by step, issue by issue, to document completely normal functioning in every regard and I was cleared. I think the difference is that the first doctor didn't take the time to ask me how I self limited my diving when ill, did not ask me what land based exercise I was doing, did not do any tests to see how I was doing NOW as opposed to when I was ill, etc.

I have had 24 amazing dives since the beginning of June. Glad that you are now diving again.