Diving with One Lung?

[DandyDon]

No, it's filled with air....Why? CA. emph, ummm, Im sure there are others but Im not coming up with them right now.

Hmmm? Then I guess it'd compress like a Free Diver's lungs at depth, and expand on ascent - and doesn't sound safe? A small change at 8,000 elevation, but a big change a depth. "Bubble, bubble, toil and trouble."

 

[slingshot]

In someone who has had a lung removed conventionally, the bronchus to that lung (the trachea technically does not plug directly into the lungs, it first divides into a left and right main bronchus which then goes to each lung) should be closed at the time of the operation. To have an open bronchus to the remaining pleural cavity would invite infection (from aspirated tracheal secretions) and would also essentially result in a pneumothorax (as air from the outside world could pass directly from the mouth to the trachea to the pleural space). In the setting of an absent lung with a closed bronchus, the contralateral lung would to some extent become hyperinflated and take up more volume in the chest than before. The remaining space is most frequently filled not with air but with fluid, usually secreted from the remaining pleural surfaces, although this may occur gradually. Air in the pleural space would gradually be absorbed into systemic blood (this is how a small pneumothorax resolves in most people). As the overall volume of functional lung is reduced, a person's ability to exchange gas efficiently is affected and any tolerance for exertion is therefore reduced. Scuba is not usually at the top of the list of recommended activities for such people, though I am in no position to comment on the situation here. Perhaps only a portion of the lung was removed? Are we making too much of an assumption to say that there is one lung due to surgery, and not a congenital absence or underdevelopment of a lung?

 

[Wildcard]

I have seen quite a few Xrays of "missing" lungs and I see air, if I rember right. Its been a while though.. If it was fluid it would compress the remaining lung. If the remaining lung expanded too far it would cause a great deal of mediastinal shift and cause further problems....What is the pathway of equalization here?

 

[slingshot]

It is true that mediastinal shift occurs following pneumonectomy (toward the side of resected lung). As to the forces at play, this is rather complex. Using a somewhat simplified model, first recall that the lung stays "inflated" because of slight negative pressure in the pleural space around the lung, generated by the "outward" action of the chest wall and diaphragm. When you inhale, the diaphragm moves downward, the chest wall expands, increasing negative pressure in the pleural space, in turn drawing the lungs "outward", i.e. causing them to expand. When something causes air to leak into the pleural space, whether from a ruptured alveolus from barotrauma or penetration of the chest wall (eg icepick), this disrupts this negative pressure and the lung can collapse. In the immediate post operative state, there is air in the space previously occupied by the removed lung. However, this air is not (normally) in contiguity with the outside world, and in fact this space will develop slight negative pressure (relative to external ambient air pressure). This is in part due to gas absorption into the blood through the pleural surface, and in part due to the previously mentioned action of chest wall and diaphragm. Pleural fluid, which the pleura normally secretes to lubricate the lung surface, moves into the space, and begins to fill the affected hemithorax. Get a chest x-ray initially, with a person upright, and you can see an air-fluid level of residual air over a line of layering fluid. As previously mentioned, the gas will be absorbed over time, and fluid continues to accumulate, until the hemithorax is filled, which on chest x-ray makes that half of the chest look "white" or opacified. The pleural space for the right and left lung is anatomically distinct, which in part accounts for why the fluid accumulates mainly on one side of the chest. The fluid accumulation does not go unchecked however as increased fluid pressure in the pleural space decreases the pressure gradient for secretion of fluid, and increases the pressure gradient for absorption of fluid (fluid moves across membranes driven by pressure gradients, or drawn by osmotic gradients, the latter not being that important here). Anyhow, here's a thumbnail of a chest x-ray from a person who had a left pneumonectomy (conventionally, a chest x-ray is displayed as if the patient imaged is facing you, and the right side of the picture is the patient's left side). Note the "white" opacified chest, as opposed to the normally aerated "dark" lung. For the connoisseur, the image has some mediastinal shift (to the person's left) and hyperexpansion of the remaining right lung. All that aside, and back to what's important, I think it's great that divebuddies is enthused about sharing our love of scuba diving with his/her father.

 

[capybara]

Hi Divebuddies,
I found this on the Diving Medicine Online web site (written by the MD who does articles for Scuba Diving magazine):
http://www.scuba-doc.com/surgdiv.html
"Pulmonary System: Patients with a thoracotomy can be certified for diving after thorough evaluation by a thoracic surgeon knowledgeable of diving medicine. Post operative wait of 12 weeks; surgical release recommended. Should be studied to rule out air trapping.
Lobectomy or pneumonectomy patients usually fill in the 'dead space' from the loss of tissue with fluid and scar. Depending on the cause of the surgery, postoperative course and results of pulmonary function and scans a person might be allowed to return to diving with the approval of their physician."

Whether a person can dive post-pneumonectomy really depends on the individual and the circumstances of the surgery. Did he have part (lobectomy) or all of his lung (pneumonectomy) removed? How long ago was it and why was this done? For example, if your father had a history of recurrent spontaneous pneumothorax and had to have a lobectomy, then diving would be contraindicated even if he had recovered, due to the risk of pneumothorax in his other lung. But if he had a remote history of TB or cancer and the problem was resolved and he was otherwise healthy with good lung function, then it may be possible to dive.

Personally, I wouldn't recommend it unless he was in excellent shape. But I am not a diving medicine specialist, and I don't know his detailed situation. I suggest your father talk to his surgeon as well as a physician familiar with diving medicine. He will likely need xrays to make sure there is no residual air (unlikely if his surgery was a long time ago) and pulmonary function tests to assess what his residual lung function is.

Wildcard, immediately postop there will be an empty air-filled cavity but it eventually fills completely with pleural fluid just as Slingshot said, unless there is a persistent air leak from the bronchial stump (called a bronchopleural fistula). The hydrostatic pressure equalizes the amount of fluid secreted and absorbed from the space so that it fills the empty space but does not compress the remaining lung. The amount of mediastinal shift caused by the remaining lung is usually minor if there is no abnormal pressure gradient in the remaining lung (such as a pneumothorax on that side).

 

[pasley]

Not a doctor, and since I am married 30 years, according to my wife, not very bright (well I was smart enough to marry you wasn't I? Ow, my eye!).

Doctors will give medical advice. But my $0.02 concern is the lack of redundancy. In short, if he should embolize his one lung in some strange way either by holding his breath or some other way, that is all she wrote.

My father lost 1/3 of one lung. From that experience, I would question his ability to tolerate the exercise. But he would know best.

 

[Wildcard]

Thanks for the great info. I was under the impression that it remained full of traped air acting like a pnumothorax. That sort of thing is out of my scope of practice. Now I know!

 

[Divebuddies]

Oh dear. This is far more complicated than I had hoped for. I'm now even more interested in what the doc has to say. I'll also check DAN for some nearby 'dive docs'. As for my father, (I'm gonna throw HIPAA out the window in the interest of scuba...) he had his lung surgically removed in 1959 when he was 10 years old due to TB. This was done in China.

Thanks for all your repies! Your information is very much appreciated.

-Divebuddies

 

[GoBlue!]

Don't worry, you haven't thrown HIPAA out the window. You didn't give any identifying information .

Jim

 

[goodknight411]

And HIPPA only applies to medical professionals giving out patient information, not to family members talking about a loved ones condition.