PMC6057342_01
US Navy decompression Table 6.
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The HBOT started three hours after the onset of symptoms and followed the US Navy Table 6 (Figure 1).
Abdominal CT scan: (a) GE in the peripheral branch of the portal system after HP ingestion; (b) reduction of the GE after HBOT.
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A pre-HBOT abdominal CT scan demonstrated multiple gas bubbles distributed in the peripheral branches of the portal system and in the lumen of the upper mesenteric, ileocolic, and colic veins (Figure 2(a)), which appeared reduced after the treatment (Figure 2(b)).
PMC6057342_02
US Navy decompression Table 6.
CRICC2018-5808390.001.jpg
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fig1
The HBOT started three hours after the onset of symptoms and followed the US Navy Table 6 (Figure 1).
Head CT scan: (a) before HBOT: gas bubbles in the basal nuclei and (b) within the subarachnoid spaces (arrows); (c) immediately after HBOT: single right frontal bubble (circle) and 4 mm: leftward deviation of the midline (arrow); (d) 14 hours after HBOT 4 mm: leftward deviation of the midline; (e) 5 days after right decompressive craniectomy: massive brain herniation with right hemispheric and left frontal ischemia.
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A CT scan of the head demonstrated many small gas bubbles within the subarachnoid spaces, the intrasellar space, and the basal nuclei (Figures 3(a) and 3(b)). A CT scan obtained immediately thereafter showed the reduction of the subarachnoid air and a single right frontal bubble; there was an effacement of the right hemispheric sulci and a 4 mm-left bound deviation of the midline (Figure 3(c)). On the next morning, at the CT scan of the brain the midline shift was increased up to 11 mm and the basal cisternae were not visible (Figure 3(d)). A wide right craniotomy was then performed to reduce the ICP but the brain herniated through the cranial breach (Figure 3(e)).
PMC6057342_03
US Navy decompression Table 6.
CRICC2018-5808390.001.jpg
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fig1
The HBOT started three hours after the onset of symptoms and followed the US Navy Table 6 (Figure 1).
(a): Air within the cortical vessels (arrows); (b) air within the ascending and thoracic descending aorta (arrows); (c) air within the coronary arteries (circle); (d) air within the aortic arch and the left ventricle.
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The CT scan of the chest and of the brain demonstrated a massive GE with evidence of multiple air bubbles inside the thoracic aorta, the left cardiac ventricle, the coronary arteries, and the cortical vessels (Figure 4).
(a) Acute myocardial infarction involving extensively the right ventricle and the septum; (b) acute cerebral infarction downstream the arteries obstructed by the GE.
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Table 6A, which was our first choice; thirty minutes before the end of the procedure an asystole appeared and the CPR was stopped 20 minutes after its occurrence. The autopsy failed to demonstrate any laceration of the lung, whose surface presented multiple wide hemorrhagic areas; the cause of the cardiogenic shock was ascribed to a hyper acute extensive myocardial infarction; a wide ischemic area was present also in the right frontal lobe (Figure 5).