Abdominal CT Scan of Decompression Sickness: A Case Report
Case Presentation: Patient is a 51-year old male that presented to the emergency department with decompression sickness. His symptoms included shortness of breath and abdominal pain. Patient stated he was diving and went down 110 feet in the water for 24 minutes and ascended for 8 minutes. When he got on the boat he began to have tingling in his extremities and abdominal pain. On physical exam, multiple areas of cyanotic marbling to the chest wall, arms, and abdominal wall were seen. Imaging Findings: CT images of the abdomen and pelvis demonstrate unique gas patterns in the systemic and portal systems. Systemic gas is present in multiple veins in the groin including the common femoral veins, subcutaneous fat, and mesentery. In images 1 and 2, the portal system gas can be appreciated and seen within the periphery of the liver. Image 3 demonstrates an axial view of the femoral veins with gas levels. The extent of gas in the femoral veins can be appreciated in the coronal view in image 4. Image 5 demonstrates gas in the inferior epigastric vein, omental veins, as well as extensive portal venous gas. Teaching point: Decompression sickness is a clinical diagnosis and does not require any imaging or tests. Patients require treatment with hyperbaric oxygen for improvement of symptoms. For this reason, imaging is not typically performed. To our knowledge, there are no published radiology case reports documenting decompression sickness in the abdomen. It is also interesting to note that decompression sickness usually presents with musculoskeletal symptoms with pain in the major joints. This patient presented with abdominal pain which prompted the CT imaging of abdomen and displayed this very unusual gas pattern.