Spontaneous Pneumothorax and Diving

[scuuba steeve]

I have a couple of question regarding spontaneous pneumothorax that I was hoping somebody could answer.

I suffered a spontaneous pneumothorax at the age of 19 in 2008. I was told this was a complete contraindication to diving and to find other activities and hobbies. I tried, but I love diving too much and have participated in several recreational dives since then, trying to limit my depth to less than one atmosphere.

Why is diving after a pneumothorax considered such a contraindication? Am I simply more likely to experience a pneumothorax at depth? If this were to happen to me at shallow depths is there a chance this could be fatal?

I have been trying to determine wether I am simply more likely to be injured or whether a pneumothorax at depth could kill me. I cannot imagine my life not including the occasional dive and plan on continuing to dive but would like a better idea of the risks. I don’t care how many times I collapse a lung, but it would be good to know what effect my depth would have on any injury. Thanks in advance for your help!

 

[CamC]

Air that escapes into the chest cavity has nowhere to go if it expands. Surfacing from even 10m down, that's a doubling of volume in a space that isn't designed for it to happen, and very bad things can result.

FWIW, I had SP too at the age of 15 - but that was 35+ years ago now. The longer that gap the less the risk, but the risk is still there.

ETA: Link to a previous thread (there are many many others):
http://www.scubaboard.com/forums/di...mothorax-disables-you-diving-forever-not.html

 

[Jim Lapenta]

It could kill you. Quite easily. A collapsed lung at depth means there is air in your chest cavity, no? Air that could expand on ascent and collapse the other lung. You do know that a person can suffer an embolism in as little as 4 feet of water? At 30 feet it could expand enough on ascent to stop your heart.

Along with that what do you think the effect would be on anyone with you? Have you actually disclosed this to those who have taken you under the water? Sure hope so as they need to know that they might be looking at getting sued by your survivors for something that was not in their control. And don't say it couldn't happen. Lawyers love grieving survivors.

 

[CamC]

Have you actually disclosed this to those who have taken you under the water?

It's disclosed to every op I dive with, and medically (re)signed off at least annually. My buddy is usually my daughter, and if the worst came to the worst she tells me the inheritance would soften the blow.

 

[TSandM]

The problem with spontaneous pneumothorax is that there is a significant recurrence rate. Many spontaneous pneumothoraces are due to abnormalities of the lung (blebs, which are like thin blisters on the surface) and people who have them often have several or many. When the abnormal lung might fail again is not predictable, if it does so underwater, the condition is very likely to be lethal, since the air escaping from the lung into the chest cavity will expand on ascent, pushing the heart and great vessels to the other side, which interferes with cardiac output and can produce cardiac arrest. Obviously, this condition cannot be treated underwater, and is very unlikely to be recognized by rescuers, who wouldn't know what to do about it anyway.

I am a very avid diver -- I can't imagine my life without diving. But if I had a spontaneous pneumothorax, I would stop.

 

[scuuba steeve]

Is it more likely to occur at depth than at the surface or is it just that if it happens, I'm hosed?

---------- Post added November 24th, 2014 at 01:52 AM ----------

Hey Cam, thanks for your reply. What made you decide that you felt safe enough to continue diving? Did you have a pleurectomy or just wait a significant time before resuming and feel as if it won't happen again. Do you have x-rays taken before a dive trip? Thanks again

 

[TSandM]

It is somewhat more likely to occur at depth, in that you have the issues of expanding gas in the lungs. Failure to exhale adequately on ascent is dangerous for anybody, but particularly for people with weak spots in their lungs. Add in the fact that a pneumo underwater is highly likely to be lethal, and you have a pretty bad situation.

If you were a decade out from your event, and had a high resolution CT of your lungs that showed no blebs or bulla, my advice might be a little less adamant.

 

[CamC]

I had a battery of tests before I was even allowed to start my pool training sessions. X-rays, various lung function tests, spiral CT. Even then, with clean results the average GP is not very likely to sign off - I was introduced to a specialist in dive medicine who was familiar with the BSAC literature who did the final sign-off. (Which is, as I've said elsewhere, an opinion, not a guarantee.)

This was some 30 years after my one and only SP, and the stats say I'm no more likely now to have another than someone who's never had one; maybe even less so, given all the tests. As TSandM points out, though, recurrence rates within the first decade are high, as high as 50%. I do love diving, but I wouldn't do it on those odds.