FAQ Can I dive after suffering a spontaneous pneumothorax?

[@kbrown3787]

Heartbreaking. I suffered a spontaneous pneumothorax right before I was set to take a freedive course, a couple of weeks ago. I just wanna hang out with the sea turtles and sharks 😞

[@DANSouthernAfrica]

Sorry to hear about that.

[@autopilotgo3181]

Same happened to me 10 years ago. I’m just gonna dive and stay shallow. Would rather die than not ever dive again

[@mecherihabib]

@@autopilotgo3181 That happen to me 2 weeks ago. The worst thing was to know it's not possible to dive again. I thought like you, dive less than 5 m , but according to my comprehension it's too dangerous, even for 2 m. 😢

[@daxrrylk8716]

21 year old patient. One small bleb (self healed). No fe-occurrence. Lung scan is clear. Considering surgery to stick lung onto chest wall. Dr. Would you say this is still a risky situation?

[@filipsolvenas7667]

I had a spontaneous pneumothorax just a couple weeks ago… I have been scuba diving since I was 14 years old and are now an advanced scuba diver - and are now 19 years old. Does the size of the pneumothorax matter? There was approximately “only” 14mm air that had left the lung - or are the same rules applied no matter the size? Also how about free diving? I would guess, due to the pressure it’s now allowed - and to clarify I mean when free diving and diving down to let’s say 10 meters.

[@DrFJCronje]

Dear Filip. Thank you for your question. The answer is not quite so simple in your case as it seems to have developed fairly late. My recommendation would be to see a Pulmonologist and have full body plethysmography and a high resolution CT of the chest. This might indicate how likely it is for you to develop another spontaneous pneumothorax, what the risk of arterial gas embolism is, whether free diving might put you at risk by precipitating another event. I would also recommend you refrain from any diving until these questions have been answered. Hope that helps! Take care. Dr Frans Cronje

[@rashiddarwish5767]

Hello Dr what about flying in an airplane?

[@DrFJCronje]

Thank you for the great question. Flying in an aeroplane is a different issue from diving for several reasons. Firstly, an ascent to a cruising altitude (and a cabin pressure of 8000 ft) represents a drop of only 1/3 of an atmosphere - from 1 ATA to about 0.7 ATA. So, the pressure differentials are vastly smaller than when diving. Secondly, unlike diving, landing improves a pneumothorax as it represents compression; conversely, return to the surface is a decompression, which may convert a simple pneumothorax into a tension pneumothorax. For this reason, pilots and aircrews have more lenient medical standards on spontaneous pneumothoraces than divers do. Hope that answers your question. Thank you for that. Dr Frans Cronje

[@DarthMalgus666]

What causes this exactly?

[@DrFJCronje]

Dear Darth. Thank you for your important question. The short answer is that anything that causes the alveolar of the long to rupture into communal clusters causes blebs and predisposes a person to a spontaneous pneumothorax, as these blebs are more prone to abnormal expansion according to La Place's Law. This may be due to connective tissue abnormalities (like Marphan or Ehlers-Danlos Syndromes) or toxic and fibrotic processes (like silicosis and smoking). Here is a comprehensive article that discusses the topic more exhaustively. Blunt force trauma to the chest may also cause blebs, so we are always wary of letting someone after a motor vehicle accident go back to diving without a chest X-ray. Many people have blebs that do not seem to cause difficulties. During the COVID-19 pandemic, many people had high-resolution CT scans. Pulmonary blebs were seen so commonly that they were not even reported later. Our pragmatic approach is that lungs without obvious abnormalities on a Chest X-ray may be assumed to be 'normal.' However, once there has been a suspicious event or if there are underlying / predisposing factors, a high-resolution CT scan is the best test to look at the structure. Lung function in the form of body plethysmography can identify possibly suspicious abnormalities, but CT remains the gold standard. Blebs, alone, are not always a contraindication to diving. Blebs in the upper parts of the lung are sometimes considered to not be dangerous. However, blebs in the parts of the lung that have high circulation are at risk of suffering gas embolism or rupture. So, these may be disqualifying. Here is the comprehensive article: www.ncbi.nlm.nih.gov/pmc/articles/PMC5569604/. Kind regards, Dr Frans Cronje

[@SlykeThePhoxenix]

I had a spontaneous pneumothorax when I was 18. Never happened again. I'm now 35, can I go diving?

[@DrFJCronje]

Thank you for your interesting question. A spontaneous pneumothorax is usually the result of a rupture of a bleb (or bullus). As many as 30-60% recur, which does mean that between 40 and 70% do not. Unfortunately, one would still want to confirm that no other blebs in the lung may over-expand, cause a pneumothorax or tension pneumothorax or precipitate arterial gas embolism. For this reason, diving is generally not recommended after spontaneous pneumothorax, even with pleurodesis. The risk needs to be individualised, however, and I recommend that you see a pulmonologist who is experienced in diving and aviation medicine. If you were my patient I would do helium dilution studies (the least invasive way of determining increased residual volume (due to bullae), followed by a high-resolution CT of the lung if there are no bullae, or they are only in the upper lung areas, you may well be able to dive again. Still, we cannot offer an objective recommendation without this. All the best, Dr. Frans Cronje

[@DANSouthernAfrica]

Thank you for your response.

[@alexakesson9797]

I got both a pleurodesis and a VATS that got rid of the bleb. Could I still return to diving or is the risk still to big?

[@mecherihabib]

I do the same, but the doctor told me I can't.😢

[@DrFJCronje]

Tthank you for your interesting question. Although pleurodesis protects against the development of a pneumothorax, one would want to confirm that no other blebs in the lung may over-expand and cause arterial gas embolism. For this reason, diving is generally not recommended after spontaneous pneumothorax, even with pleurodesis. The risk needs to be individualised, however, and I would recommend that you see a pulmonologist who is experienced in diving and aviation medicine.

[@DANSouthernAfrica]

@@DrFJCronje Thank you for your response.