Caisson disease

Mesenteric

venous thrombosis as a rare complication of decompression sickness. CT imaging before HBOT. a A large amount of intravenous gas was detected in the portal vein (white arrow) and b superior mesenteric vein (white arrow). c CT imaging after transfer to our hospital revealed pneumatosis intestinalis of the transverse colon (white arrow)

surgicalcasereports.springeropen.com • CC-by-4.0

A case of

decompression illness not responding to hyperbaric oxygen. T1-weighted MRI scan showing cortical white matter and subcortical and deep periventricular small ischaemic lesions of old and new age

jintensivecare.biomedcentral.com • CC-by-4.0

Dysbaric

osteonecrosis of the humerus. MR arthrography, coronal fs T2-WI (A and B): the peripheral borders are strongly hyperintense (red arrow), while the center of the lesion remains hypointense (white asterisk).

www.eurorad.org • CC by-nc-sa-4.0

Radiopaedia • CC-by-nc-sa 3.0 • de

Decompression sickness (DCS), also known as diver's disease, aerobullosis, the bends or caisson disease, is an uncommon diving-related decompression illness that is an acute neurological emergency typically occurring in deep sea divers.

Clinical Presentation

Decompression sickness can be further clinically subdivided into:

mild symptoms: arthralgia, skin marbling, small patchy hemorrhages, and lymphatic obstruction
serious and life-threatening symptoms: affecting the brain, spinal cord, inner ear, and/or lung

Pathology

Nitrogen gas bubbles can cause neurovascular infarction of the brain and spinal cord leading to neurological deficit. There are various theories to explain this, which hypothesize between arterial occlusion, venous infarction and cellular nitrogen toxicity.

Location

The white matter tracts of the spinal cord and brain are predominantly affected due to their high myelin content. Cord lesions are more common than brain lesions. In the spinal cord, there is a predilection for the thoracic cord segments to be affected, thought to be secondary to more nitrogen accumulating in the lateral and posterior columns where there is higher fat content and also the relatively low blood flow compared to the cervical and lumbar segments.

Complications

Radiographic features

MRI

Radiological changes are seen in early stages in MRI, but have very low specificity. The affected white matter may show ischemic lesions or the bubbles themselves. There may also be an accumulation of nitrogen bubbles in marrow fat.

Normal MRI of the cord does not rule out the diagnosis . If there are MRI findings, these tend to normalize after a few weeks.