{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T11:38:00Z","timestamp":1788781080850,"version":"build-2803163510"},"reference-count":14,"publisher":"Diving and Hyperbaric Medicine Journal","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diving Hyperb Med"],"abstract":"<jats:p>We present the case of a 28-year-old female diver who performed a scuba air dive with significant omitted decompression obligation. She developed constitutional and neurological symptoms. Brain magnetic resonance imaging post treatment demonstrated multifocal embolic infarcts and transthoracic echocardiogram with bubble contrast on day three revealed a persistent foramen ovale (PFO) and severe right ventricular (RV) dilatation. We postulate that the high venous bubble load from the provocative decompression caused an increase in pulmonary artery pressure, leading  to RV dilatation and increased right to left shunting of bubbles across her PFO, resulting in significant neurological deficits. This mechanism is analogous to that seen in acute thromboembolic pulmonary embolism.<\/jats:p>","DOI":"10.28920\/dhm55.1.59-64","type":"journal-article","created":{"date-parts":[[2025,3,17]],"date-time":"2025-03-17T22:57:16Z","timestamp":1742252236000},"page":"59-64","source":"Crossref","is-referenced-by-count":2,"title":["Severe neurological decompression sickness associated with right ventricular dilatation and a persistent foramen ovale"],"prefix":"10.28920","volume":"55","author":[{"name":"Department of Hyperbaric Medicine, Fiona Stanley Hospital, Murdoch, WA, Australia","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy S","family":"Mason","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Wilmshurst","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Cardiology Department, Royal Stoke University Hospital, Stoke on Trent, United Kingdom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian C","family":"Gawthrope","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Department of Hyperbaric Medicine, Fiona Stanley Hospital, Murdoch, WA, Australia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"University of Notre Dame, Fremantle, WA, Australia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil D","family":"Banham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Department of Hyperbaric Medicine, Fiona Stanley Hospital, Murdoch, WA, Australia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"11463","published-online":{"date-parts":[[2025,3,31]]},"reference":[{"key":"ref0","doi-asserted-by":"publisher","unstructured":"1 Kasper W, Geibel A, Tiede N, Just H. Patent foramen ovale in patients with haemodynamically significant pulmonary embolism. Lancet. 1992;340(8819):561-4. doi: 10.1016\/0140-6736(92)92102-l. PMID: 1355152.","DOI":"10.1016\/0140-6736(92)92102-L"},{"key":"ref1","unstructured":"2 Defence and Civil Institute of Environmental Medicine, Department of National Defence - Canada. DCIEM diving manual: air decompression procedures and tables. Universal Dive Techtronics, Inc. (UDT); 1992."},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"3 Arjomand A, Holm JR, Gerbino AJ. Severe decompression sickness associated with shock and acute respiratory failure. Case Rep Crit Care. 2020;2020:8855060. doi: 10.1155\/2020\/8855060. PMID: 33204543. PMCID: PMC7661127.","DOI":"10.1155\/2020\/8855060"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"4 Mendez N, Huchim-Lara O, Rivera-Canul N, Chin W, Tec J, Cordero-Romero S. Fatal cardiopulmonary decompression sickness in an untrained fisherman diver in Yucat\u00e1n, Mexico: a clinical case report. Undersea Hyperb Med. 2017;44:279-81. doi: 10.22462\/5.6.2017.8. PMID: 28779584.","DOI":"10.22462\/5.6.2017.8"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"5 El-Ghawabi SH, Mansour MB, Youssef FL, el-Ghawabi MH, Abd el-Latif MM. Decompression sickness in caisson workers. Br J Ind Med. 1971;28:323-9. doi: 10.1136\/oem.28.4.323. PMID: 5124832. PMCID: PMC1069450.","DOI":"10.1136\/oem.28.4.323"},{"key":"ref5","unstructured":"6 Wilmshurst PT, Byrne JC, Webb-Peploe MM. Relation between interatrial shunts and decompression sickness in divers. In: Sterk W, Geeraedts L, editors. EUBS 1990 proceedings. Amsterdam: Foundation for hyperbaric medicine; 1990. p. 147-53."},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"7 Verstappen FT, Bernards JA, Kreuzer F. Effects of pulmonary gas embolism on circulation and respiration in the dog. I. Effects on circulation. Pflugers Arch. 1977;368:89-96. doi: 10.1007\/BF01063459. PMID: 558602.","DOI":"10.1007\/BF01063459"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"8 Vik A, Brubakk AO, Hennessy TR, Jenssen BM, Ekker M, Sl\u00f8rdahl SA. Venous air embolism in swine: transport of gas bubbles through the pulmonary circulation. J Appl Physiol (1985). 1990;69:237-44. doi: 10.1152\/jappl.1990.69.1.237. PMID: 2203724.","DOI":"10.1152\/jappl.1990.69.1.237"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"9 Elliott CG. Pulmonary physiology during pulmonary embolism. Chest. 1992;101:163S-171S. doi: 10.1378\/chest.101.4_supplement.163s. PMID: 1555481.","DOI":"10.1378\/chest.101.4_Supplement.163S"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"10 Liew J, Stevens J, Slatore C. Refractory hypoxemia in a patient with submassive pulmonary embolism and an intracardiac shunt: a case report and review of the literature. Perm J. 2018;22:17-61. doi: 10.7812\/TPP\/17-061. PMID: 29616915. PMCID: PMC5882180.","DOI":"10.7812\/TPP\/17-061"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"11 Konstantinides S, Geibel A, Kasper W, Olschewski M, Bl\u00fcmel L, Just H. Patent foramen ovale is an important predictor of adverse outcome in patients with major pulmonary embolism. Circulation. 1998;97:1946-51. doi: 10.1161\/01.cir.97.19.1946. PMID: 9609088.","DOI":"10.1161\/01.CIR.97.19.1946"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"12 Vijayvergiya R, Shrivastava S. Coronary air embolism during transcatheter closure of atrial septal defect. Indian Heart J. 2016;68:S79-S80. doi: 10.1016\/j.ihj.2016.01.007. PMID: 27751336. PMCID: PMC5067790.","DOI":"10.1016\/j.ihj.2016.01.007"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"13 Dib J, Boyle AJ, Chan M, Resar JR. Coronary air embolism: a case report and review of the literature. 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