Diagnoses: Pulmonary bleb

Can I safely dive after being diagnosed with a pulmonary bleb? I am healthy and fit with no history of pneumothorax.
The responsibility for the decision of whether to dive is generally left up to the individual and his or her physician. This decision, however, should be based on a medical evaluation and awareness of the risks involved in scuba diving.
Your best resource is a physician, preferably a pulmonologist, trained in dive medicine. A physician without the relevant experience may be thinking in terms of above-water activities and may not recognize the inherent dangers of breathing compressed gas at increased atmospheric pressure. A physician familiar with dive medicine would not likely give medical clearance to an individual diagnosed with a pulmonary bleb, which is a small blister or pocket of air trapped between the lung and the outer surface of the lung (visceral pleura). These spots are weaker than the normal lining of the lung and can occasionally break and cause air to leak from the lung into the chest cavity. A person who has pleural blebs usually has more than one, and all blebs are prone to leak at some time.
At depth there is normally a reduction in breathing capacity and an increase in breathing resistance caused by the higher gas density. At 33 feet, the maximum breathing capacity of the average scuba diver is only 70 percent of the surface value, and at 100 feet it is only 50 percent. The pressures on the lung caused by diving are likely to stimulate a bleb to rupture and leak air into the chest cavity. When this happens, the result is a spontaneous pneumothorax (collapsed lung). The lung collapse can occur without provocation or warning. Above water, pneumothorax is often associated with exercising, straining while lifting or performing some other physical task, but many times the affected individual is doing nothing out of the ordinary.
Since barotrauma can occur with hyperinflation of lung tissue, a diver's lungs must be able to tolerate rapid changes in volume and pressure. Any weakness in lung structure or architecture may be predisposed to rupture from even slight overinflation in an otherwise healthy person. Pulmonary barotrauma, which can lead to rupture of the lung air sacs (alveoli), usually happens toward the end of a dive, even a shallow one. Escaping gas can enter one of four places: the subcutaneous tissues of the neck and chest wall; the area around the heart, causing pneumomediastinum (mediastinal emphysema); the pleural space between the lung and chest wall, causing pneumothorax; or the bloodstream, causing arterial gas embolism (AGE).
Please remember that most divers and dive-boat personnel are not trained to provide first aid to a diver with pneumothorax. While generally manageable above water, a spontaneous pneumothorax in the diving environment is likely to be fatal.
If you would like to be referred to a physician trained in dive medicine, call +1-919-684-2948 or email medic@dan.org.
— Frances Smith, EMT-P, DMT
The responsibility for the decision of whether to dive is generally left up to the individual and his or her physician. This decision, however, should be based on a medical evaluation and awareness of the risks involved in scuba diving.
Your best resource is a physician, preferably a pulmonologist, trained in dive medicine. A physician without the relevant experience may be thinking in terms of above-water activities and may not recognize the inherent dangers of breathing compressed gas at increased atmospheric pressure. A physician familiar with dive medicine would not likely give medical clearance to an individual diagnosed with a pulmonary bleb, which is a small blister or pocket of air trapped between the lung and the outer surface of the lung (visceral pleura). These spots are weaker than the normal lining of the lung and can occasionally break and cause air to leak from the lung into the chest cavity. A person who has pleural blebs usually has more than one, and all blebs are prone to leak at some time.
At depth there is normally a reduction in breathing capacity and an increase in breathing resistance caused by the higher gas density. At 33 feet, the maximum breathing capacity of the average scuba diver is only 70 percent of the surface value, and at 100 feet it is only 50 percent. The pressures on the lung caused by diving are likely to stimulate a bleb to rupture and leak air into the chest cavity. When this happens, the result is a spontaneous pneumothorax (collapsed lung). The lung collapse can occur without provocation or warning. Above water, pneumothorax is often associated with exercising, straining while lifting or performing some other physical task, but many times the affected individual is doing nothing out of the ordinary.
Since barotrauma can occur with hyperinflation of lung tissue, a diver's lungs must be able to tolerate rapid changes in volume and pressure. Any weakness in lung structure or architecture may be predisposed to rupture from even slight overinflation in an otherwise healthy person. Pulmonary barotrauma, which can lead to rupture of the lung air sacs (alveoli), usually happens toward the end of a dive, even a shallow one. Escaping gas can enter one of four places: the subcutaneous tissues of the neck and chest wall; the area around the heart, causing pneumomediastinum (mediastinal emphysema); the pleural space between the lung and chest wall, causing pneumothorax; or the bloodstream, causing arterial gas embolism (AGE).
Please remember that most divers and dive-boat personnel are not trained to provide first aid to a diver with pneumothorax. While generally manageable above water, a spontaneous pneumothorax in the diving environment is likely to be fatal.
If you would like to be referred to a physician trained in dive medicine, call +1-919-684-2948 or email medic@dan.org.
— Frances Smith, EMT-P, DMT
Posted in Alert Diver Spring Editions
Tagged with Pulmanologist, Lung injuries, Pulmonary Bleb, Pneumothorax, Dive medicine
Tagged with Pulmanologist, Lung injuries, Pulmonary Bleb, Pneumothorax, Dive medicine
Categories
2020
January
February
Group Fitness at the PoolHow to Rescue a Distressed diver at the SurfaceHow to manage Near-DrowningNo Sit-ups no problem How to manage MalariaHow to manage Oxygen Deficiency (Hypoxia)What to do when confronted by a sharkHow to manage Scombroid PoisoningHow to perform a Deep Diver RescueHow to perform One-rescuer CPRHow to perform a Neurological Assessment
March
DAN’s Quick Guide to Properly Disinfecting Dive GearCOVID-19 : Prevention Recommendations for our Diving CommunityGermophobia? - Just give it a reasonable thoughtScuba Equipment care – Rinsing and cleaning diving equipmentCOVID-19 and DAN MembershipFurther limitations imposed on travels and considerations on diving activitiesDAN Membership COVID-19 FAQsLancet COVID-19 South African Testing SitesCOVID-19 No Panic Help GuideGetting Decompression Sickness while FreedivingDown in the DumpsCardiovascular Disease and DivingDelayed Off-GassingDiving after Dental surgeryDiving with Multiple MedicationsPygmy Seahorses: Life AquaticAfrica DustCOVID-19 Myth BustersScuba Units Are Not Suitable Substitutes for VentilatorsDisinfection of Scuba Equipment and COVID-19Physioball Stability Exercises
April
COVID-19 AdvisoryScuba Equipment Care - Drying & Storing Your GearTransporting Diving Lights & BatteriesHow to Pivot Your Message During a CrisisTourism Relief FundCOVID-19 Business Support ReviewDiving After COVID-19: What We Know TodayEUBS-ECHM Position Statement on Diving ActivitiesPart 2: COVID-19 Business Support ReviewPress Release
May
Diving in the Era of COVID-19Dive Operations and COVID-19: Prepping for ReturnCOVID-19 & Diving Activities: 10 Safety RecommendationsCOVID-19: Surface Survival TimesThe Philippines at its FinestThe Logistics of ExplorationThe Art of the Underwater SelfieShooter: Douglas SeifertFAQs Answered: Disinfecting Scuba EquipmentStock your First-Aid KitResearch and OutreachCovid-19 ResearchOut of the BlueEffects of Aspirin on DivingThe New Pointy end of DivingDiving and Hepatitis CCaissons, Compressed-Air work and Deep TunnellingPreparing to Dive in the New NormalNew Health Declaration Form Sample Addressing C-19 IssuesDiving After COVID 19: What Divers Need to Know
June
Travel Smarter: PRE-TRIP VACCINATIONSAttention-Deficit/Hyperactivity Disorder and DivingCOVID-19: Updated First Aid Training Recommendations From DANDiving with a Purpose in National Marine SanctuariesStay Positive Through the PandemicFor the Dive Operator: How to Protect Your Staff & ClientsStudying Deep reefs and Deep diversAsking the Right QuestionsLung squeeze under cold diving conditions
July
Dive DeprivationVolunteer Fish Surveys: Engage DiversDAN Member Profile: Mehgan Heaney-GrierTravel Smarter: Don’t Cancel, Reschedule InsteadDive Boat Fire SafetyRay of HopePartner ExercisesDiving at AltitudeAluminium ExposureHip FracturesAcoustic NeuromaGuidelines for Lifelong Medical Fitness to DiveNew Dive Medical Forms
August
Women in Diving: Lauren Arthur, Conservationist & Natural History Story TellerWomen in Diving: Dr Sara Andreotti White Shark ResearcherTiming ExerciseWomen in Diving: The Salty Wanderer, Charlie WarlandWomen in Diving: Beth Neale, Aqua soul of freedivingWomen in Diving: Diving and spearfishing Diva, Jean HattinghWomen in Diving: Zandile Ndhlovu, The Black Mermaid
September
October
Freediving For ScienceStep Exercises with CardioFluorescence Imaging help Identify Coral BleachingChildren and DivingThe Watchman device and divingScuba Diving and Factor V Leiden gene mutationNitrogen Narcosis at shallow depthsOil and Particulates: Safe levels in Breathing Air at depthDive Principles for Coping with COVID-19The Importance of a Predive Safety CheckTalya Davidoff: the 'Plattelandse Meisie' Freediver
2019
February
April
May
DAN Press ReleaseYour Dive Computer: Tips and tricks - PART 1Your Dive Computer: Tips and tricks - PART 2Aural HygieneDCS AheadHow Divers Can Help with coral conservationRed Tide and shellfish poisoningDiving after Kidney DonationDiving with hypertrophic cardiomyopathyEmergency Underwater Oxygen Recompression
June
July
September
October
November
Exercise drills with DowelsHeart-rate TrainingCultivating ConservationTRavel Smarter : Evaluating an unfamiliar Dive operatorChallenging the Frontiers of Decompression ResearchTravel Smarter: Plan for Medical EmergenciesWhen should I call my Doctor?DAN Student Medical Expense CoverageAdvice, Support and a LifelineWetsuits and heat stressDiving after Chiropractic adjustments
2018
April
Flying after pool diving FAQLung squeeze while freediving FAQDiving after Bariatric surgery FAQMarine injuries FAQVasovagal Syncope unpredictable FAQIncident report procedure FAQDiving after knee surgery FAQDiving when in RemissionDive with orbital Implant FAQInert gas washout FAQOxygen ears FAQPost Decompression sicknessChildren and diving. The real concerns.Diving after SurgeryPhysiology of Decompresssion sickness FAQDiving and regular exerciseGordon Hiles - I am an Underwater Cameraman and Film MakerScuba Air QualityBreath-hold diving. Part 3: The Science Bit!Compensation Legislation and the Recreational DiverCape Town DivingFive pro tips for capturing better images in cold waterThe Boat Left Without You: Now What?
May
When things go wrongEmergency Planning: Why Do We Need It?Breath-hold diving: Running on reserve -Part 5 Learning to RebreatheSweet Dreams: When Can I Resume Diving Post Anaesthesia?Investing in the future of reefsTo lie or not to lie?THE STORY OF A RASH AFTER A DIVEFirst Aid KitsTaravana: Fact or Falacy?
June
Oxygen Unit MaintenanceKnow Your Oxygen-Delivery Masks 1Know Your Oxygen-Delivery Masks 2Emergency Oxygen unitsInjuries due to exposure - HypothermiaInjuries due to exposure - Altitude sicknessInjuries due to Exposure - Dehydration and other concernsHow to plan for your dive tripThe Future of Dive MedicinePlastic is Killing our ocean
September
Return to DivingDiagnoses: Pulmonary blebSide effects of Rectogesic ointmentDiving with ChemotherapyReplacing dive computers and BCDsCustomize Your First-Aid KitPlan for medical emergenciesHow the dive Reflex protects the brain and heartDry suits and skin BendsAltitude sickness and DCSScuba Diving and Life Expectancy
2017
March
April
Incident Insight: TriageA Field Guide to Minor MishapsSnorkels: Pros & ConsTime & RecoveryMedication & Drug UseDiving with CancerNitrox FAQCOPD FAQHyperbaric Chamber FAQJet Lag FAQHydration FAQAnticoagulant Medication FAQFluid in the Ear FAQEye Surgery FAQElderly Divers FAQNitrogen FAQHealth Concerns FAQMotion Sickness FAQMicronuclei FAQ
June
August
2016
February
March
Breath-Hold Diving & ScubaReturn to Diving After DCITiming Exercise & DivingHot Tubs After DivingSubcutaneous EmphysemaIn-Water RecompressionDiving at AltitudeFlying After DivingDiving After FlyingThe Risks of Diabetes & DivingFlu-like Symptoms Following a DiveHand & Foot EdemaFrontal HeadachesBladder DiscomfortLatex AllergiesRemember to BreatheProper Position for Emergency CareAches & PainsCell Phones While DrivingSurfers Ear Ear Ventilation TubesDealing with Ear ProblemsDiving with Existing Ear InjuriesPerforated Ear DrumENT SurgeryUnpluggedCochlear ImplantsPortuguese Man-of-WarJellyfish StingsLionfish, Scorpionfish & Stonefish EnvenomationsStingray Envenomation Coral Cuts, Scrapes and RashesSpeeding & Driving Behaviour
June
Newsflash! Low Pressure Hose DeteriorationItching & rash go away & come back!7 Things we did not know about the oceanMigraine HeadacheAttention Deficit Disorder Cerebral Vascular AccidentEpilepsyCerebral PalsyHistory of SeizuresMultiple Sclerosis Head TraumaBreast Cancer & Fitness to Dive IssuesLocal Allergic ReactionsSea LiceHow ocean pollution affects humans Dive Fatality & Lobster Mini-Season StatisticsPregnancy & DivingReturn to Diving After Giving BirthBreast Implants & DivingMenstruation During Diving ActivitiesOral Birth ControlBreast FeedingPremenstrual SyndromeOsteoporosisThe Aftermath of Diving IncidentsCompensation Legislation & the Recreational DiverNoise-Induced Hearing LossLegal MattersThe Nature of Liability & DivingDAN Legal NetworkWaivers, Children & Solo DivingHealthy, but overweight!Taking Medication while Scuba DivingGetting Fit for the Dive SeasonBone Considerations in Young DiversAsthma and Scuba DivingHepatitisDiving with HyperglycemiaShoulder PainDiving After Spinal Back Surgery
August
Hazard Identification & Risk AssessmentCaring For Your People Caring For Your FacilitiesCaring For Your BusinessScuba Air Quality Part 1Scuba Air Quality Part 2Chamber Maintenance Part 1Chamber Maintenance Part 2The Aging Diver Propeller SafetyRelease The PressureDon't Get LostMore Water, Less Bubbles13 Ways to Run Out of Air & How Not To7 Mistakes Divers Make & How To Avoid ThemSafety Is In The AirHow Good Is Your Emergency Plan
2015
January
March