read more ), under the skin of the neck and upper chest (subcutaneous emphysema), or into the blood vessels (air embolism-see Unusual Types of Emboli Unusual types of emboli Pulmonary embolism is the blocking of an artery of the lung (pulmonary artery) by a collection of solid material brought through the bloodstream (embolus)-usually a blood clot (thrombus) or. Air can enter the mediastinum when The small air sacs of the lungs (alveoli) become stretched and torn. Alternatively, air may be forced out of the lungs into the tissues surrounding the heart ( pneumomediastinum Pneumomediastinum Pneumomediastinum is air in the cavity in the central part of the chest (mediastinum). Air that leaks out of the lungs can be trapped in the space between the lungs and the chest wall and expand, causing the lungs to collapse ( pneumothorax Pneumothorax A pneumothorax is the presence of air between the two layers of pleura (thin, transparent, two-layered membrane that covers the lungs and also lines the inside of the chest wall), resulting. Overinflation of the lungs can rupture small air sacs, allowing air to leak out. The lungs, gastrointestinal tract, part of the face covered. read more ), and facial pain or a bloody nose ( sinus barotrauma Sinus barotrauma (sinus squeeze) Barotrauma is tissue injury caused by a change in pressure, which compresses or expands gas contained in various body structures. read more ), vertigo or ear pain ( ear barotrauma Ear barotrauma (ear squeeze) Barotrauma is tissue injury caused by a change in pressure, which compresses or expands gas contained in various body structures. read more ), bloodshot eyes ( mask barotrauma Mask barotrauma (mask squeeze) Barotrauma is tissue injury caused by a change in pressure, which compresses or expands gas contained in various body structures. These differences make the blood mass transfer toward the thorax, and results in pulmonary hypertension and consequent pulmonary barotraumas ( 5).Symptoms vary and may include breathing problems or chest pain ( pulmonary barotrauma Pulmonary (lung) barotrauma Barotrauma is tissue injury caused by a change in pressure, which compresses or expands gas contained in various body structures. Also, in case of head-out water immersion, alveolar pressure is similar to atmospheric pressure, whereas extra-thoracic vascular pressure is similar to hydrostatic pressure. Relative pulmonary hypertension leads to an increased pressure gradient between the pulmonary capillaries and pulmonary parenchyma. The pressure difference causes blood circulation from the peripheral portion (extremities) to the central portion of the body (heart, lungs, and great vessels of the chest) and enlarges the venous return and cardiac preload ( 3 4). Additionally, the coldness induced by water increases this hemodynamic strain ( 1 2). During breath holding while swimming (including snorkeling), immersion in a reversed position causes a pressure difference between the thorax and lower extremities. In previous literature regarding alveolar hemorrhage as a complication of barotrauma caused by SCUBA diving, the increase in the intra-alveolar pressure due to breath holding in the water and the mechanism of barotrauma, which induced intra-alveolar hemorrhage, appeared to be similar to those seen in our case. His breath sounds were normal, without any crackle or abnormal sounds.
Hemoptysis was his only complaint, and there were no other symptoms. Although he was fully conscious and lucid, he appeared to be acutely ill. His body temperature was within normal range, with no chills or other upper respiratory symptoms. He presented to the emergency department of our hospital with a pulse rate of 90 beats per minute and respiratory rate of 20 breaths per minute. He denied any accompanying aspiration of water or other respiratory symptoms, including shortness of breath. After snorkeling, he noticed blood-tinged sputum while coughing. Several hours before admission, he had been snorkeling in the late afternoon at a river for 1 hour, without any traumatic injury to his chest. He snorkeled about twice a year without any problems, and this was the first attack he had experienced. This was not his first attempt at snorkeling, and he had more than 5 years of snorkeling experience. He had been well before the current attack. He reported with approximately 20–30 mL of expectorated blood mixed with sputum. A healthy 54-year-old man with hemoptysis and a previous medical history of well-controlled hypertension (body weight, 74.5 kg height, 168 cm body mass index, 26.14 kg/m 2) visited our hospital.
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