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Righini et al1 are to be thanked for reporting their case of portal venous thrombosis and the associated finding of gas bubbles in the gastric vein and portal system. They indicate that bubbles have not been previously identified by computed tomography in relation to decompression sickness.However, Bird reported such findings in 2007.2 It is our experience at UCSD that intrahepatic and portal venous gas is not particularly rare following decompression stress. We have recently initiated a prospective study utilizing ultrasonography to quantify that impression.
We do not find the explanation offered by the authors for the presence of portal gas to be compelling. They attribute the bubbles to the diver having consumed a large amount of beer prior to his descent (timing of ingestion not provided). Intragastric bubbles present from normobaric ingestion prior to a dive are quite unlikely to compress and re-expand beyond their initial volume during the course of a dive. Gastric distension may arise from beer bubbles acquired during at-depth ingestion (not recommended), but bubbles present prior to descent will, at most, expand upon ascent to their original volume. The parameters of the patient’s dive are considered bubble-genic and that, in and of itself, is the likely cause of the portal gas.
Kim Buschmann, MD
Anthony Medak, MD
Faculty of Undersea and Hyperbaric Medicine, University of California, San Diego, California
1. Righini M, Gueddi S, Maurel B, et al. SCUBA diving and portal vein thrombosis: a case report. Clin J Sport Med. 2010;20:497-499.
2. Bird N. CT finding of VGE in the portal veins and IVC in a diver with abdominal pain: a case report. Undersea Hyperb Med. 2007;34:393-397.