Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University.
Department of Cardiology, Shizuoka Hospital, Juntendo University.
Undersea Hyperb Med. 2024 Second Quarter;51(2):185-187.
A 60-year-old man with hypertension and dyslipidemia complained of chest pain upon ascending from a maximum depth of 27 meters while diving. After reaching the shore, his chest pain persisted, and he called an ambulance. When a physician checked him on the doctor's helicopter, his electrocardiogram (ECG) was normal, and there were no bubbles in his inferior vena cava or heart on a portable ultrasound examination. The physician still suspected that he had acute coronary syndrome instead of decompression illness; therefore, he was transported to our hospital. After arrival at the hospital, standard cardiac echography showed a flap in the ascending aorta. Immediate enhanced computed tomography revealed Stanford type A aortic dissection. The patient obtained a survival outcome after emergency surgery. To our knowledge, this is the first reported case of aortic dissection potentially associated with scuba diving. It highlights the importance of considering aortic dissection in patients with sudden-onset chest pain during physical activity. In addition, this serves as a reminder that symptoms during scuba diving are not always related to decompression. This report also suggests the usefulness of on-site ultrasound for the differential diagnosis of decompression sickness from endogenous diseases that induce chest pain. Further clinical studies of this management approach are warranted.
一位 60 岁的男性，有高血压和血脂异常病史，在潜水至最大深度 27 米后上升时主诉胸痛。抵达岸边后，他的胸痛持续存在，并呼叫了救护车。当一名医生在医生的直升机上对他进行检查时，他的心电图（ECG）正常，便携式超声检查也未发现下腔静脉或心脏有气泡。医生仍怀疑他患有急性冠状动脉综合征而非减压病；因此，他被转送到我们医院。抵达医院后，标准心脏超声显示升主动脉有一个瓣片。立即进行增强计算机断层扫描显示 Stanford 型 A 型主动脉夹层。患者在紧急手术后获得了生存结果。据我们所知，这是首例可能与水肺潜水相关的主动脉夹层报告。它强调了在活动时突发胸痛的患者中考虑主动脉夹层的重要性。此外，这提醒我们，水肺潜水时的症状并不总是与减压有关。该报告还表明，现场超声在鉴别减压病与引起胸痛的内源性疾病方面具有诊断价值。需要进一步进行该管理方法的临床研究。
