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(Chest. 2001;120:2098-2100.)
© 2001 American College of Chest Physicians

Hemoptysis Provoked by Voluntary Diaphragmatic Contractions in Breath-Hold Divers*

Esen Kiyan, MD; Samil Aktas, MD and Akin Savas Toklu, MD

* From the Department of Chest Medicine (Dr. Kiyan), and Department of Undersea and Hyperbaric Medicine (Drs. Aktas and Toklu), Istanbul University, Istanbul, Turkey.

Correspondence to: Samil Aktas, MD, Istanbul Universitesi, Istanbul Tip Fakültesi, Deniz ve Sualti Hekimligi AD, 34390, Capa, Istanbul-Turkiye; e-mail: aktasmil{at}hotmail.com

Pulmonary barotrauma of descent (lung squeeze) has been described in breath-hold divers when the lung volume becomes smaller than the residual volume (RV), with the effect of increased ambient pressure. However, the ratio between the total lung capacity and the RV is not the only factor that plays a role in the lung squeeze. Blood shift into the thorax is another important factor. We report three cases of hemoptysis in breath-hold divers who dove for spear fishing in shallower depths than usual. All of the divers performed voluntary diaphragmatic contractions at the beginning of their ascent, while their mouths and noses were closed. We suggest that the negative intrathoracic pressure due to the forced attempt to breathe in with voluntary diaphragmatic contractions contributes to alveolar hemorrhage, since it may damage the pulmonary capillaries.

Key Words: alveolar hemorrhage • breath-hold diving • hemoptysis






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