Case report: tracheobronchial diverticulum, a potential risk for diving?

• Published in: Frontiers in medicine Vol. 10; p. 1340974
• Main Authors: Qing, Long, Wang, Yan, Zhang, Meng, Pu, Qinqin, Cai, Wanwan, Pan, Yaping, Xia, Delin
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 11.01.2024
• Subjects: barotrauma; computed tomography; decompression; diving; fitness to dive; Medicine; tracheobronchial diverticulum; computed tomography; barotrauma; diving; decompression; tracheobronchial diverticulum; fitness to dive
• ISSN: 2296-858X; 2296-858X
• DOI: 10.3389/fmed.2023.1340974

Tracheobronchial diverticulum (TBD) is an asymptomatic, benign cystic lesion outside the lumen of the trachea and bronchus. This is the first report case of a SCUBA (self contained underwater breathing apparatus) diver diagnosed with TBD, which is a potential risk to diving. No literature or guideline is available so far on the diving fitness for patients with congenital or acquired TBD condition. A healthy 26-year-old male professional diver has records of SCUBA diving up to a depth of 40 meters sea water. He did not have any diving-related injuries or symptoms during his career and had no history of smoking, drinking, or other special illnesses except for a COVID-19 infection. A tracheal diverticulum was found accidentally by computed tomography (CT), but its communication with the trachea was not clear initially. Therefore, high-resolution CT and electronic bronchoscopy were done to clarify the situation of the diverticulum and identify the diving risk. High-resolution CT showed a possible opening in the diverticulum, but this was not seen under electronic bronchoscopy. Although a potential opening was shown in high-resolution CT, the lack of visual bronchoscopic evidence made it likely to be a dead cavity. As there is a higher theoretical risk of barotrauma during decompression, leading to pneumomediastinum, hemorrhage, or arterial gas embolism, the current clinical consensus is that air-containing tissue should be regarded as a relative contraindication for diving. Overall, it is recommended that the diver should dive carefully and avoid ascending too rapidly.