Study of Radiological Findings and Management of Decompression Sickness

Huh,  Jae Taeck

J Korean Soc Emerg Med > Volume 10(4); 1999 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 1999;10(4): 667-679.

Study of Radiological Findings and Management of Decompression Sickness

ABSTRACT

BACKGROUND: The aim of this study are to detect the radiological findings of decompression sickness that could elucidate the pathogenesis of decompression sickness and to evaluate the results of management of decompression sickness with hyperbaric oxygen therapy.
METHODS:
Forty nine patients(42 men and 7 women; 23-51, mean 32 years) were referred to the Hyperbaric Oxygen Therapy Center of Dong-A University Hospital for diving related injuries. All patients were studied neurologically and radiologically. Forty patients(81.6%) were type 1 decompression sickness who complained pains in various sites. Eight patients(16.3%) were type 2 decompression sickness with spinal cord involvement and underwent MR examination of the spinal cord. One patient(2.0%) was type 2 decompression sickness with chest involvement. Two patients(4.1%) among nine patients of type 2 decompression sickness were combined with type 3 decompression sickness who was suspected of cerebral embolization. All patients of type 1 were treated with therapeutic hyperbaric recompressions of US Navy treatment table 5 and auxiliary therapy. Six patients of type 2 were treated with US Navy treatment table 6 and two patients of type 3 were treated with US Navy treatment table 6A.
RESULTS:
Magnetic Resonance Image(MRI) demonstrated patchy areas of increased signal intensity in the spinal cord on both T2-weighted and fast SE T2-weighted images in five patients with symptoms of spinal cord injury, corresponding to an area of the cord believed to be clinically involved. Chest X-ray and spiral computed tomogrphy(CT) scan demonstrated patchy area in right middle lobe of lung in type 2 decompression sickness of chest involvement and disappeared two weeks later with hyperbaric oxygen therapy. All patients of type 1 decompression sickness were improved with hyperbaric oxygen therapy and auxiliary therapy. Motor weakness of extrimities were improved immediately during hyperbaric therapy within hyperbaric chamber in six patients among eight patients of type 2 decompression sickness with spinal cord involvementbut. Two patients who were not improved during first time of hyperbaric oxygen therapy were remained neurological deficit 6 months later. One patient of type 2 decompression sickness with chest involvement were also improved with hyperbaric oxygen therapy and auxiliary therapy. Two patients of type 3 decompression sickness combined with type 2 were also improved neurologically after hyperbaric oxygen therapy with auxiliary therapy.
CONCLUSION:
MRI has proved to be reliable in the detection of spinal cord involvement due to decompression sickness that were previously undetectable by other neuroradiological investigations(such as myelography, CT, angiography, isotopic tests) and its pathologic findings might be corresponded to ischemic injury of spinal cord. Patch area which was demonstrated by chest spiral CT and chest P-A of type 2 decompression sickness might be related to hemorrhage of lung parenchyme due to alveolar rupture which was resolve two weeks later. Therapeutic hyperbaric recompression is very effective in the management of decompression sickness.