Portal Venous Gas from Decompression Sickness – Case Report and Literature Review

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Methods Patient records were reviewed for clinical presentation, imaging findings, treatment course, and symptomatic resolution. A literature review was conducted to provide support for the case and provide background information for the unique presentation. Results We present a case of PVG secondary to DCS in an experienced scuba diver after repeated dives to depths greater than 150 meters. Patient presented with nausea, vomiting, confusion, nystagmus, ataxia, and a rash on the upper chest and back. After PVG was identified on CT, hyperbaric oxygen therapy was initiated. Symptoms resolved within the span of 3 days. Conclusion PVG is a rare and easily treatable phenomenon in DCS. It is important to identify the etiology of the PVG in the case of DCS to enact appropriate treatment. Gas embolism Decompression injury Caisson disease Figures Figure 1 Figure 2 Introduction Portal venous gas (PVG) secondary to decompression sickness (DCS) in scuba diving is a rare phenomenon that, if left untreated, can result in tissue ischemia and organ dysfunction. The presence of hepatic PVG secondary to DCS is easily resolved with hyperbaric oxygen therapy, although PVG can also indicate lethal etiologies such as mesenteric ischemia, bowel necrosis, and bowel perforation, which would require prompt surgical intervention. We present a unique case of portal venous gas (PVG) secondary to decompression sickness (DCS) complicated by imaging findings of emphysematous cystitis of unknown relation. Case Report A 49-year-old experienced diver with no known medical history presented to the ED with chief complaints of nausea and vomiting. History of present illness revealed the patient went scuba diving 154 ft below sea level for a total dive time of 48 minutes. After resurfacing, the patient experienced nausea and shoulder aches. His symptoms were relieved after 2 hours of rest. He made a second dive to the same depth of 154 feet for an unspecified period but quickly resurfaced with severe symptoms of nausea and vomiting along with back rash, jaw pain, dizziness, and shoulder pain. He was treated immediately with oxygen 3 L/min via nasal cannula and given 4 mg Zofran before transferring to Banner University Medical Center-Phoenix. At the emergency department, vitals demonstrated tachycardia at 115 bpm, mild tachypnea at 23 breaths/min and hyperglycemia with blood glucose at 279 mg/dL. Blood pressure and SpO2 were within normal limits. Physical exam indicated mild confusion, moderate distress, ataxia, nystagmus, and mottled/cyanotic rash involving the upper chest and back, which arose after resurfacing from the second dive. Labs indicated dehydration with leukocytosis (WBC: 14.4K/µL) and polycythemia (HgB: 17.8g/dL). Arterial Blood Gas was remarkable high anion gap metabolic acidosis with a pH of 7.43, pCO2 of 28, and an anion gap of 17. Differentials included acute decompression sickness, nitrogen narcosis, and new onset Diabetes Mellitus. The patient was admitted to telemedicine and received a bolus of fluids with continuous nasal cannula therapy. Patient underwent computed tomography scans of the head and neck, which excluded acute brain injury. CT angiography chest/abdomen/pelvis with contrast was significant for portal venous gas, shown as small tubular radiolucencies extending to the liver periphery (Fig. 1 ). No CT evidence of bowel ischemia, perforation, or pneumatosis was noted. Incidentally, patient was found to have nephrolithiasis, nonspecific perinephric fat stranding, and mild emphysematous cystitis (Fig. 2 ). The toxicology team was consulted, and patient underwent hyperbaric oxygen therapy on day 2. Therapy followed the Navy Dive Table 6 protocol, which is considered the standard of care for decompression sickness. This consists of a compression phase of about 5 minutes long to a depth of 18 msw under 100% O2 and 4 oxygen cycles lasting 20 minutes each with short air intervals. Patients then undergo a decompression phase which includes 9 msw and 2 O2 cycles which are 60 minutes each followed by a slow return to surface pressure [ 1 ]. Post treatment, the patient expressed improvement in his dizziness and joint pain, although symptoms were still present. On day 3, the patient underwent hyperbaric oxygen therapy following Navy Dive Table 5 protocol, which is similar to the Table 6 protocol with shorter and fewer oxygen cycles. He completed the treatment without complications and reported resolution of symptoms. He was discharged on day 4 without scheduled follow-up imaging. Discussion DCS occurs in situations where there is rapid tissue decompression, most commonly seen in deep divers or high-altitude aviators. Repetitive dives without adherence to decompression schedules or quick ascent from deep-sea diving results in a rapid pressure reduction that promotes the accumulation of gases previously dissolved in tissue and blood vessels to form gas emboli in the venous circulation [ 2 ]. It is hypothesized that gas emboli expand during ascent, resulting in collections in large venous systems such as the portal vein and vena cava. In severe cases, air emboli can cause end-organ damage, neurologic symptoms mimicking stroke, apnea, and even cardiovascular collapse [ 3 ]. Only a few case reports and one retrospective chart review have described PVG as a sequela of DCS [ 4 – 7 ]. In the emergency setting with acute-onset nausea and vomiting, the presence of hepatic PVG is a critical imaging finding that may represent lethal etiologies such as mesenteric ischemia, bowel necrosis, and bowel perforation, which would require prompt surgical intervention. As such, radiologists should be aware that DCS can manifest as HPV to avoid over diagnosing acute bowel pathology. Recognizing portal venous gas consequential to barotrauma was essential to avoid the risk of an unnecessary operation in our patient. Despite the patient’s history of barotrauma, the presence of emphysematous cystitis (EC) led to suspicion of underlying bowel pathology. In rare cases, EC can present with pneumoperitoneum, which raises suspicion for bladder perforation [ 8 ]. EC is more likely to observed patients untreated Diabetes Mellitus (DM), as in this patient, and results from infection with aerogenic bacterial organisms, such as Escherichia coli and Klebsiella pneumoniae [ 9 – 10 ]. Our patient had no indications of pneumoperitoneum thereby, ruling out the need for surgical intervention. While no follow-up imaging was acquired to determine status of portal venous gas, the patient reported resolution of symptoms with hyperbaric oxygen therapy. We strongly recommend consideration be given to DCS as a cause of acute PVG. While an uncommon etiology, DCS should be a primary differential in coastal communities or for patients who experience rapid ambient pressure changes (ie divers, pilots, hyperbaric specialists). PVG is typically due to a benign process when isolated and asymptomatic. However, in the presence of acute bowel symptoms and incidental findings that predispose to bowel injury like in our case, a comprehensive list of differentials is critical to avoid mischaracterization that could lead to adverse clinical outcomes. Conclusion We present a case of portal venous gas secondary to DCS in an experienced scuba diver after repeated dives to depths greater than 150 meters. PVG is a rare and understudied phenomenon in decompression sickness. We substantiate the literature by presenting a case report to improve radiographic characterization of PVG and patient care. Declarations Funding: Not applicable Conflicts of interest/Competing interests: On behalf of all authors, the corresponding author states that there is no conflict of interest. Ethics approval: Not applicable (include appropriate approvals or waivers) Consent to participate: Not applicable Written Consent for publication: Obtained from the patient. Availability of data and material: Not applicable Code availability: Not applicable Author contribution statement: DK reviewed data on the case, interpreted results, conducted literature review and prepared manuscript. LO identified the case and assisted in data analysis and manuscript preparation. TP was involved in direct care of the patient and completed final review of the manuscript. References Cortegiani, Andrea & Foresta, Grazia & Strano, Giustino & Strano, Maria & Montalto, Francesca & Garbo, Domenico & Raineri, Maurizio. (2013). An Atypical Case of Taravana Syndrome in a Breath-Hold Underwater Fishing Champion: A Case Report. Case reports in medicine. 2013. 939704. https://doi.org/10.1155/2013/939704 Mitchell SJ, Bennett MH, Moon RE. Decompression sickness and arterial gas embolism. N Engl J Med 386(13):1254-1264, 2022. https://doi.org/10.1056/NEJMra2116554 Alexander AM, Martin N. Arterial Gas Embolism. [Updated 2022 Apr 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546599/ Kondo A, Nagawasa H, Takeuchi I, Yanagawa Y. Portal Venous Gas Due to Decompression Sickness. Intern Med. 2018 Jul 15;57(14):2091. https://doi.org/10.2169/internalmedicine.0418-17 Morita S, Yamagiwa T, Inokuchi S. Portal venous gas on computed tomography imaging in patients with decompression sickness. J Emerg Med. 2013 Jul;45(1):e7-11. https://doi.org/10.1016/j.jemermed.2012.11.039 Siaffa R, Luciani M, Grandjean B, Coulange M. Massive portal venous gas embolism after scuba diving. Diving Hyperb Med. 2019 Mar 31;49(1):61-63. https://doi.org/10.28920/dhm49.1.61-63 Oyaizu T, Enomoto M, Tsujimoto T, Kojima Y, Okawa A, Yagishita K. Elimination of CT-detected gas bubbles derived from decompression illness with abdominal symptoms after a short hyperbaric oxygen treatment in a monoplace chamber: a case report. Undersea Hyperb Med. 2017 Mar-Apr;44(2):167-171. https://doi.org/10.22462/3.4.2017.11 Murata Y, Matsuo Y, Hiraoka E. Successful Conservative Management of Emphysematous Cystitis With Pneumoperitoneum: A Case Report and Literature Review. Cureus. 2023 Aug 19;15(8):e43769. https://doi.org/10.7759/cureus.43769 Schicho A, Stroszczynski C, Wiggermann P. Emphysematous Cystitis: Mortality, Risk Factors, and Pathogens of a Rare Disease. Clin Pract. 2017;7:930. https://doi.org/10.4081/cp.2017.930 Y, Matsuo Y, Hiraoka E. Successful Conservative Management of Emphysematous Cystitis With Pneumoperitoneum: A Case Report and Literature Review. Cureus. 2023 Aug 19;15(8):e43769. https://doi.org/10.7759/cureus.43769 Cite Share Download PDF Status: Published Journal Publication published 23 Nov, 2024 Read the published version in SN Comprehensive Clinical Medicine → Version 1 posted Editorial decision: Accept 31 Oct, 2024 Reviewers agreed at journal 04 Jul, 2024 Reviewers invited by journal 04 Jul, 2024 Editor assigned by journal 25 Jun, 2024 First submitted to journal 23 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4433789","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":322767709,"identity":"3b3873de-c30e-4464-b513-44a6312440c1","order_by":0,"name":"Dalia Koujah","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5ElEQVRIiWNgGAWjYDCCM0AswXBAjoGBsQEqlECcFmMStTAwHEhsQAgR0MJ35vAxCYuaO+n9sw83f/i4w46Bnz3HAK8WybNtaRISx57lzjiX2GA480wyg2TPG/xaDM7zmElIsB3ObTjD2JDM28bMYHCDgC0QLf8Op8sDtRzmbatnsCeo5WyPmYRk2+EEgzOMjc28bYcZDCQI+eXMsWQLyb7DhhvPMDYzzmw7ziNx5lkBXi18Z5IP3pb4dlhe7gz74w8f26rl+NuTN+DVAgLMEkgcHoLKQYDxA1HKRsEoGAWjYMQCAH7ySo9Xtpu8AAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0002-2923-9029","institution":"UA College of Medicine Phoenix: The University of Arizona College of Medicine Phoenix","correspondingAuthor":true,"prefix":"","firstName":"Dalia","middleName":"","lastName":"Koujah","suffix":""},{"id":322767710,"identity":"7772b530-7cbd-4129-9bcb-a83506d5653b","order_by":1,"name":"Liam O'Neill","email":"","orcid":"","institution":"Banner - University Medical Center Phoenix","correspondingAuthor":false,"prefix":"","firstName":"Liam","middleName":"","lastName":"O'Neill","suffix":""},{"id":322767711,"identity":"79c4e82a-40c8-49a8-b7b7-c703cd4ab491","order_by":2,"name":"Tarang Patel","email":"","orcid":"","institution":"Banner - University Medical Center Phoenix","correspondingAuthor":false,"prefix":"","firstName":"Tarang","middleName":"","lastName":"Patel","suffix":""}],"badges":[],"createdAt":"2024-05-17 02:44:32","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4433789/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4433789/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s42399-024-01748-5","type":"published","date":"2024-11-23T15:57:53+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":61358488,"identity":"b7e189a2-a81f-4581-94ec-ff41eee3ee6b","added_by":"auto","created_at":"2024-07-29 21:19:21","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":665829,"visible":true,"origin":"","legend":"\u003cp\u003eCoronal non-contrast enhanced of chest, abdomen, and pelvis in the soft tissue (a) and lung (b) windows. Locules of gas are visualized in the portal venous tree and bladder wall, consistent with portal venous gas and emphysematous cystitis\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4433789/v1/26bf9b3cfacd3fc93beef88b.png"},{"id":61358487,"identity":"f1a41c8e-c98a-4323-bf01-c6f12f8e5598","added_by":"auto","created_at":"2024-07-29 21:19:20","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":745430,"visible":true,"origin":"","legend":"\u003cp\u003e(a, b, c) Axial non-contrast CT of the abdomen in the soft tissue window showing portal venous gas as small tubular radiolucencies extending to the liver periphery. (d) Axial non-contrast CT of the pelvis in the soft tissue window showing gas in the bladder wall indicative of emphysematous cystitis\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4433789/v1/41f3cee5c978a82efc8d06ee.png"},{"id":69834960,"identity":"e62eaa99-5025-472e-b50a-b7aefe0abe45","added_by":"auto","created_at":"2024-11-25 16:10:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2278638,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4433789/v1/c6d1e832-0d60-49a4-9b1f-1d53a6b48b74.pdf"}],"financialInterests":"","formattedTitle":"Portal Venous Gas from Decompression Sickness – Case Report and Literature Review","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePortal venous gas (PVG) secondary to decompression sickness (DCS) in scuba diving is a rare phenomenon that, if left untreated, can result in tissue ischemia and organ dysfunction. The presence of hepatic PVG secondary to DCS is easily resolved with hyperbaric oxygen therapy, although PVG can also indicate lethal etiologies such as mesenteric ischemia, bowel necrosis, and bowel perforation, which would require prompt surgical intervention.\u003c/p\u003e \u003cp\u003eWe present a unique case of portal venous gas (PVG) secondary to decompression sickness (DCS) complicated by imaging findings of emphysematous cystitis of unknown relation.\u003c/p\u003e"},{"header":"Case Report","content":"\u003cp\u003eA 49-year-old experienced diver with no known medical history presented to the ED with chief complaints of nausea and vomiting. History of present illness revealed the patient went scuba diving 154 ft below sea level for a total dive time of 48 minutes. After resurfacing, the patient experienced nausea and shoulder aches. His symptoms were relieved after 2 hours of rest. He made a second dive to the same depth of 154 feet for an unspecified period but quickly resurfaced with severe symptoms of nausea and vomiting along with back rash, jaw pain, dizziness, and shoulder pain. He was treated immediately with oxygen 3 L/min via nasal cannula and given 4 mg Zofran before transferring to Banner University Medical Center-Phoenix.\u003c/p\u003e\u003cp\u003eAt the emergency department, vitals demonstrated tachycardia at 115 bpm, mild tachypnea at 23 breaths/min and hyperglycemia with blood glucose at 279 mg/dL. Blood pressure and SpO2 were within normal limits. Physical exam indicated mild confusion, moderate distress, ataxia, nystagmus, and mottled/cyanotic rash involving the upper chest and back, which arose after resurfacing from the second dive. Labs indicated dehydration with leukocytosis (WBC: 14.4K/µL) and polycythemia (HgB: 17.8g/dL). Arterial Blood Gas was remarkable high anion gap metabolic acidosis with a pH of 7.43, pCO2 of 28, and an anion gap of 17. Differentials included acute decompression sickness, nitrogen narcosis, and new onset Diabetes Mellitus. The patient was admitted to telemedicine and received a bolus of fluids with continuous nasal cannula therapy.\u003c/p\u003e\u003cp\u003ePatient underwent computed tomography scans of the head and neck, which excluded acute brain injury. CT angiography chest/abdomen/pelvis with contrast was significant for portal venous gas, shown as small tubular radiolucencies extending to the liver periphery (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). No CT evidence of bowel ischemia, perforation, or pneumatosis was noted. Incidentally, patient was found to have nephrolithiasis, nonspecific perinephric fat stranding, and mild emphysematous cystitis (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe toxicology team was consulted, and patient underwent hyperbaric oxygen therapy on day 2. Therapy followed the Navy Dive Table\u0026nbsp;6 protocol, which is considered the standard of care for decompression sickness. This consists of a compression phase of about 5 minutes long to a depth of 18 msw under 100% O2 and 4 oxygen cycles lasting 20 minutes each with short air intervals. Patients then undergo a decompression phase which includes 9 msw and 2 O2 cycles which are 60 minutes each followed by a slow return to surface pressure [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Post treatment, the patient expressed improvement in his dizziness and joint pain, although symptoms were still present. On day 3, the patient underwent hyperbaric oxygen therapy following Navy Dive Table\u0026nbsp;5 protocol, which is similar to the Table\u0026nbsp;6 protocol with shorter and fewer oxygen cycles. He completed the treatment without complications and reported resolution of symptoms. He was discharged on day 4 without scheduled follow-up imaging.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eDCS occurs in situations where there is rapid tissue decompression, most commonly seen in deep divers or high-altitude aviators. Repetitive dives without adherence to decompression schedules or quick ascent from deep-sea diving results in a rapid pressure reduction that promotes the accumulation of gases previously dissolved in tissue and blood vessels to form gas emboli in the venous circulation [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. It is hypothesized that gas emboli expand during ascent, resulting in collections in large venous systems such as the portal vein and vena cava.\u003c/p\u003e \u003cp\u003eIn severe cases, air emboli can cause end-organ damage, neurologic symptoms mimicking stroke, apnea, and even cardiovascular collapse [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Only a few case reports and one retrospective chart review have described PVG as a sequela of DCS [\u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the emergency setting with acute-onset nausea and vomiting, the presence of hepatic PVG is a critical imaging finding that may represent lethal etiologies such as mesenteric ischemia, bowel necrosis, and bowel perforation, which would require prompt surgical intervention. As such, radiologists should be aware that DCS can manifest as HPV to avoid over diagnosing acute bowel pathology. Recognizing portal venous gas consequential to barotrauma was essential to avoid the risk of an unnecessary operation in our patient.\u003c/p\u003e \u003cp\u003eDespite the patient\u0026rsquo;s history of barotrauma, the presence of emphysematous cystitis (EC) led to suspicion of underlying bowel pathology. In rare cases, EC can present with pneumoperitoneum, which raises suspicion for bladder perforation [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. EC is more likely to observed patients untreated Diabetes Mellitus (DM), as in this patient, and results from infection with aerogenic bacterial organisms, such as Escherichia coli and Klebsiella pneumoniae [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Our patient had no indications of pneumoperitoneum thereby, ruling out the need for surgical intervention. While no follow-up imaging was acquired to determine status of portal venous gas, the patient reported resolution of symptoms with hyperbaric oxygen therapy.\u003c/p\u003e \u003cp\u003eWe strongly recommend consideration be given to DCS as a cause of acute PVG. While an uncommon etiology, DCS should be a primary differential in coastal communities or for patients who experience rapid ambient pressure changes (ie divers, pilots, hyperbaric specialists). PVG is typically due to a benign process when isolated and asymptomatic. However, in the presence of acute bowel symptoms and incidental findings that predispose to bowel injury like in our case, a comprehensive list of differentials is critical to avoid mischaracterization that could lead to adverse clinical outcomes.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWe present a case of portal venous gas secondary to DCS in an experienced scuba diver after repeated dives to depths greater than 150 meters. PVG is a rare and understudied phenomenon in decompression sickness. We substantiate the literature by presenting a case report to improve radiographic characterization of PVG and patient care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eFunding: Not applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConflicts of interest/Competing interests: On behalf of all authors, the corresponding author states that there is no conflict of interest.\u003c/p\u003e\n\u003cp\u003eEthics approval: Not applicable (include appropriate approvals or waivers)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsent to participate: Not applicable\u003c/p\u003e\n\u003cp\u003eWritten Consent for publication: Obtained from the patient.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAvailability of data and material: Not applicable\u003c/p\u003e\n\u003cp\u003eCode availability: Not applicable\u003c/p\u003e\n\u003cp\u003eAuthor contribution statement: DK reviewed data on the case, interpreted results, conducted literature review and prepared manuscript. LO identified the case and assisted in data analysis and manuscript preparation. TP was involved in direct care of the patient and completed final review of the manuscript.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCortegiani, Andrea \u0026amp; Foresta, Grazia \u0026amp; Strano, Giustino \u0026amp; Strano, Maria \u0026amp; Montalto, Francesca \u0026amp; Garbo, Domenico \u0026amp; Raineri, Maurizio. (2013). An Atypical Case of Taravana Syndrome in a Breath-Hold Underwater Fishing Champion: A Case Report. Case reports in medicine. 2013. 939704. https://doi.org/10.1155/2013/939704\u003c/li\u003e\n\u003cli\u003eMitchell SJ, Bennett MH, Moon RE. Decompression sickness and arterial gas embolism. N Engl J Med 386(13):1254-1264, 2022. https://doi.org/10.1056/NEJMra2116554 \u003c/li\u003e\n\u003cli\u003eAlexander AM, Martin N. Arterial Gas Embolism. [Updated 2022 Apr 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546599/\u003c/li\u003e\n\u003cli\u003eKondo A, Nagawasa H, Takeuchi I, Yanagawa Y. Portal Venous Gas Due to Decompression Sickness. Intern Med. 2018 Jul 15;57(14):2091. https://doi.org/10.2169/internalmedicine.0418-17 \u003c/li\u003e\n\u003cli\u003eMorita S, Yamagiwa T, Inokuchi S. Portal venous gas on computed tomography imaging in patients with decompression sickness. J Emerg Med. 2013 Jul;45(1):e7-11. https://doi.org/10.1016/j.jemermed.2012.11.039 \u003c/li\u003e\n\u003cli\u003eSiaffa R, Luciani M, Grandjean B, Coulange M. Massive portal venous gas embolism after scuba diving. Diving Hyperb Med. 2019 Mar 31;49(1):61-63. https://doi.org/10.28920/dhm49.1.61-63 \u003c/li\u003e\n\u003cli\u003eOyaizu T, Enomoto M, Tsujimoto T, Kojima Y, Okawa A, Yagishita K. Elimination of CT-detected gas bubbles derived from decompression illness with abdominal symptoms after a short hyperbaric oxygen treatment in a monoplace chamber: a case report. Undersea Hyperb Med. 2017 Mar-Apr;44(2):167-171. https://doi.org/10.22462/3.4.2017.11 \u003c/li\u003e\n\u003cli\u003eMurata Y, Matsuo Y, Hiraoka E. Successful Conservative Management of Emphysematous Cystitis With Pneumoperitoneum: A Case Report and Literature Review. Cureus. 2023 Aug 19;15(8):e43769. https://doi.org/10.7759/cureus.43769 \u003c/li\u003e\n\u003cli\u003eSchicho A, Stroszczynski C, Wiggermann P. Emphysematous Cystitis: Mortality, Risk Factors, and Pathogens of a Rare Disease. Clin Pract. 2017;7:930. https://doi.org/10.4081/cp.2017.930\u003c/li\u003e\n\u003cli\u003eY, Matsuo Y, Hiraoka E. Successful Conservative Management of Emphysematous Cystitis With Pneumoperitoneum: A Case Report and Literature Review. Cureus. 2023 Aug 19;15(8):e43769. https://doi.org/10.7759/cureus.43769\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"sn-comprehensive-clinical-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sncm","sideBox":"Learn more about [SN Comprehensive Clinical Medicine](https://www.springer.com/journal/42399)","snPcode":"42399","submissionUrl":"https://submission.nature.com/new-submission/42399/3","title":"SN Comprehensive Clinical Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Gas embolism, Decompression injury, Caisson disease","lastPublishedDoi":"10.21203/rs.3.rs-4433789/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4433789/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003ePurpose\u003c/b\u003e\u003c/p\u003e \u003cp\u003eTo present a case report involving a rare case of a scuba diver presenting with portal venous gas (PVG) from decompression sickness (DCS).\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003ePatient records were reviewed for clinical presentation, imaging findings, treatment course, and symptomatic resolution. A literature review was conducted to provide support for the case and provide background information for the unique presentation.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eWe present a case of PVG secondary to DCS in an experienced scuba diver after repeated dives to depths greater than 150 meters. Patient presented with nausea, vomiting, confusion, nystagmus, ataxia, and a rash on the upper chest and back. After PVG was identified on CT, hyperbaric oxygen therapy was initiated. Symptoms resolved within the span of 3 days.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003ePVG is a rare and easily treatable phenomenon in DCS. It is important to identify the etiology of the PVG in the case of DCS to enact appropriate treatment.\u003c/p\u003e","manuscriptTitle":"Portal Venous Gas from Decompression Sickness – Case Report and Literature Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-29 21:19:16","doi":"10.21203/rs.3.rs-4433789/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Accept","date":"2024-11-01T03:48:46+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2024-07-04T16:52:29+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-07-04T14:12:50+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-25T23:22:29+00:00","index":"","fulltext":""},{"type":"submitted","content":"SN Comprehensive Clinical Medicine","date":"2024-06-23T23:43:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"sn-comprehensive-clinical-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sncm","sideBox":"Learn more about [SN Comprehensive Clinical Medicine](https://www.springer.com/journal/42399)","snPcode":"42399","submissionUrl":"https://submission.nature.com/new-submission/42399/3","title":"SN Comprehensive Clinical Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"b52ba0e2-2665-467b-bc93-ea71eea72759","owner":[],"postedDate":"July 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-11-25T16:03:24+00:00","versionOfRecord":{"articleIdentity":"rs-4433789","link":"https://doi.org/10.1007/s42399-024-01748-5","journal":{"identity":"sn-comprehensive-clinical-medicine","isVorOnly":false,"title":"SN Comprehensive Clinical Medicine"},"publishedOn":"2024-11-23 15:57:53","publishedOnDateReadable":"November 23rd, 2024"},"versionCreatedAt":"2024-07-29 21:19:16","video":"","vorDoi":"10.1007/s42399-024-01748-5","vorDoiUrl":"https://doi.org/10.1007/s42399-024-01748-5","workflowStages":[]},"version":"v1","identity":"rs-4433789","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4433789","identity":"rs-4433789","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}