An overextension of the lungs with the above named resulting complications is suspected to be the second most cause of death in divers after drowning [5]. With regards to our patient, pressure-related partial pleural tears with consecutive forming of emphysematous bullae must be assumed (in absence of a recalled diving trauma or incidence), located on that part of the lungs, that is highly exposed to shear stress and pressure variation in the thorax: the outer sheathing

of the lungs. Fast ascent, even out of lower water depth, or fast changes in diving Selleckchem JNK inhibitor depth due to hunting after a fish, could have caused the marked lung changes in our patient. The intermittent cigarette smoking at this time must be taken into account as a contributing factor to the described mechanism, as it causes air trapping (as

do bronchial infections with partial or complete mucus plugging in the distal bronchioles), that prevents airflow out of the airways [4]. The distinct distribution of the bullae and the septated appearance support the assumption, that the underlying cause in origin is trauma, rather than emphysematous changes resulting from cigarette-smoking. Apposedly, lung function testing showed normal values except slight impaired diffusion capacity, no further emphysematous changes throughout the lungs could be detected in the CT-scan (as should be expected in long-term cigarette smoking). No medical investigation or x-ray of the lungs took place in the past, so that the existence of the www.selleckchem.com/products/gdc-0068.html emphysematous bullae at an earlier stage (longer than three years) can only be hypothesised. In the actual context, the origin of the emphysema has no therapeutic consequence, but shows – once again – how important thorough questioning ID-8 of

the patient with regards to the past history could be. Due to recurrent infection of the bullae and preserved lung-function, surgical resection has to be considered intermediate-term, at this stage impossible though, as the patient is under dual platelet aggregation-inhibition and the conservative treatment results were fully satisfactory. Future aim should be close surveillance of the patient and detecting eventual corresponding changes to prevent further complications. – Unusual distribution of emphysema in lung imaging should lead to consideration of differential diagnoses Many thanks to Dr. med. David Semmler, Mainz, Germany and Dr. med. Stefan Seemayer, Wiesbaden, Germany, for the support regarding the professional contents of this case report. “
“Bleomycin-induced pneumonitis (BIP) is a serious adverse effect of bleomycin, which is used in chemotherapy regimens in patients with testicular cancer or Hodgkin’s lymphoma [1].