Decompression Sickness
A 42-year-old man presented to the emergency department with palpitations, arthralgias, and vomiting 2 hours after scuba diving to a depth of 26 m. The physical examination revealed diffuse violaceous skin mottling over his trunk and arms (Panel A). Laboratory values were notable for mild elevations in levels of serum aminotransferases, creatine kinase, and lactate. Given the extent of the nausea and vomiting as well as the elevated lactate level, abdominal computed tomography was performed, which showed air in the portal venous system (Panel B). The skin mottling, also known as cutis marmorata, is a recognized dermatologic manifestation of decompression sickness. Air in the portal venous system can also be a complication of decompression sickness. Its incidence is unknown, since abdominal imaging is not routinely performed for this diagnosis. The air in the portal system is thought to arise when a diver ascends too quickly and air expands rapidly, which damages the surrounding tissue. The patient underwent treatment with hyperbaric oxygen. The skin mottling and abdominal pneumatosis resolved after two sessions in the hyperbaric chamber. Qing Sun, M.D. Guangkai Gao, M.D. No. 401 Hospital of the People’s Liberation Army, Qingdao, China source: nejm.org
