Intramedullary Gas Detected on Computed Tomography in Cases of Decompression Sickness: A Case Series

Decompression sickness (DCS) is caused by nitrogen gas bubbles in the blood that lead to bubble embolization and tissue compression. Intramedullary gas bubbles may also be observed; however, their clinical significance remains unclear. Herein, we describe our experiences with three cases that experienced DCS in which intramedullary gas bubbles were incidentally discovered on computed tomography (CT) performed before treatment. Case 1 involved a 28-year-old male who had repeatedly dived to 30 m and surfaced. After diving, the patient experienced pain in the left lower extremity. CT revealed bubbles in the right atrium, hip joint, and humeral marrow cavity. Case 2 was a 55-year-old male who had dived for 25 min to a maximum depth of 42 m. Thirty minutes after diving, the patient experienced nausea and thigh pain. CT revealed bubbles in the brachiocephalic vein, pulmonary artery, femoral vein, intrahepatic portal vein, and the femoral bone marrow cavity. Case 3 was a 52-year-old female who dived to 50 m before abruptly surfacing. Subsequently, the patient experienced dizziness and nausea. CT revealed bubbles in the mediastinum, intrahepatic portal vein, femoral vein, and brachial bone marrow cavity. These findings demonstrate that gas bubbles may be observed within the bone marrow on CT scans of patients with mild cases of DCS.