Usefulness of Ultrasound for Differentiating between Decompression Sickness and Drowning in the Emergency Room

Abstract

A 47-year-old woman, who had been diving 6 times, panicked during diving training and surfaced suddenly after a 15-minute dive at a depth of 19 meters. She had nausea, vomiting, and headache immediately after surfacing. Decompression sickness (DCS) was suspected, and she was transported to the emergency room (ER) of our hospital by ambulance. Upon arrival, she had mild consciousness disturbance and hypoxia requiring oxygen. Her symptoms remained. She initially received 12 L per minute of oxygen and rapid infusion for DCS. However, ultrasound study showed no air bubbles in the inferior vena cava or portal vein. Trunk computed tomography (CT) showed infiltrative lesions in the bilateral lung fields without gas in any vessels. The diagnosis was drowning with alternobaric vertigo. She was treated with an antibiotic without recompression therapy. The patient's dizziness and vomiting subsided quickly. Her post-admission course was uneventful and she was discharged to her home on the 9th hospital day. We report a case in which ultrasound was useful for differentiating between DCS and drowning. When patients have symptoms after diving, confirmation of the presence of gas in the heart or vessels using ultrasound in the acute phase is important for the diagnosis of DCS.