Pulmonary
barotrauma of ascent is a well-recognized risk of
compressed air diving in the civilian and military diving communities. Chest imaging is a beneficial adjunct to clinical evaluation in screening select individuals for fitness to dive, evaluating dive-related
injuries, and safely returning individuals to diving duty. We present a case of a 26-year-old male U.S. Navy Ensign and Basic Underwater Demolition/SEAL (BUD/S) candidate who experienced pulmonary
barotrauma following two shallow dives to a maximum depth of 18 feet of seawater using the MK-25 100%
oxygen rebreather. A chest radiograph showed a left upper lobe peripheral wedge-shaped opacity abutting the pleural surface. A subsequent computerized tomography (CT) scan of the chest showed multifocal areas of peripheral pulmonary
hemorrhage associated with small pneumatoceles. Two months after the diving
injury, chest CT showed resolution of the pulmonary
hemorrhage and pneumatoceles. Diving-related pulmonary
barotrauma occurs most often secondary to breath-holding on ascent by inexperienced divers and is one of the most common diving
injuries seen in BUD/S candidates. The risk of pulmonary
barotrauma may be decreased through adequate training and thorough medical screening to include assessing for symptoms of
infection before every dive. In cases of acute pulmonary
barotrauma, chest radiographs may be used to screen for
thoracic injury. Chest CT with inspiratory and expiratory sequences should be used to screen dive candidates on a case-by-case basis and to evaluate
lung injury and predisposing pulmonary conditions following pulmonary
barotrauma.