Right cardiac chambers echo-bubble contrast in a patient with decompression sickness: A case report and a literature review

Abstract

Background: so far there is no available modality to fully confirm the diagnosis, however, the application of echocardiography in suspected DCS cases has been more frequently used, in this case, transthoracic echocardiography (TTE) was used to detect micro-bubbles in the right cardiac chambers and monitor the patient after hyperbaric oxygen therapy (HBOT); which proposes the possible applicability of TTE in diagnosing and monitoring DCS patients. Case presentation: This report describes a 54-year-old fisherman who was referred to the emergency department with dyspnea and mild confusion after rapid ascend of a saturation diving of 50m sea depth. After the initial evaluation, he was assessed using TTE to exclude the presence of structural heart diseases, where it surprisingly showed spontaneous echo contrast inside the right cardiac chambers similar to agitated saline echo testing, the patient then was admitted for HBOT and follow-up; rapid improvement was noticed after the first HBOT session and the TTE findings were fully resolved. Conclusion: TTE could be considered in the initial workup when DCS is suspected, and it might have a role in monitoring DCS patients if echocardiographic findings of bubbles formation were documented in the pre-hyperbaric therapy settings.