Abstract
Background
Injuries in divers resulting purely from impact with the water are uncommon in the
published literature. We present a case report of pulmonary contusion in a young diver.
Case Report
A young, healthy competitive platform diver landed flat on his back in the water from
a dive of 10 meters. He complained of upper back pain and had an episode of hemoptysis
after the dive. He was initially observed for 15 hours postinjury, and was discharged
when three chest radiographs (CXRs) taken at 1, 7, and 11 hours postinjury did not
show significant abnormalities. Thirty-six hours postinjury, the patient experienced
repeat hemoptysis and returned to the emergency department, where a fourth CXR performed
43 hours postinjury was normal. A computed tomography (CT) scan revealed pulmonary
contusion and traumatic subpleural pneumatoceles. The patient was admitted to the
cardiothoracic ward for observation. He recovered well with conservative treatment
and was discharged on the fifth day after injury with clearance for air travel. In
this patient with a high-energy mechanism of rapid deceleration and hemoptysis at
the scene, there may be grounds for performing a CT scan of the thorax at the time
of the first presentation, although the CT findings did not change conservative management
of this patient.
Why Should an Emergency Physician Be Aware of This?
Emergency physicians should recognize that a dive into water may generate sufficient
impact to produce a pulmonary contusion. If the patient is clinically well and the
CXR results are normal, the decision to initiate a CT scan and subsequent disposition
may be based on clinical judgement and institutional practice.
Keywords
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Article info
Publication history
Published online: September 28, 2016
Accepted:
July 19,
2016
Received:
June 20,
2016
Footnotes
Reprints are not available from the authors.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
