Q. I produced phlegm with brown specks after freediving. Is it serious?

Answered by
Dr. Amolkumar W Diwan
and medically reviewed by Dr. Preetha J
This is a premium question & answer published on Oct 26, 2020

Hi doctor,

Two weeks ago, I had lung barotrauma (lung squeeze) from freediving (breath-hold diving). I dive to a depth of 76 meters. Upon surfacing, I felt fine, with no chest congestion, pain, or urge to cough. About 12 hours later, I produced some phlegm that was brown, which indicates old blood. I still felt fine, but the next morning I produced some more phlegm with brown specks. It has now been two weeks, and yet, I am producing phlegm with brown specks. I know its blood as I am using forensics testing kits that detect blood. There has been a reduction in the brown specks, but it is still concerning. I have had small squeezes in the past, but it always has chest congestion symptoms or an urge to cough. Then I will produce some phlegm with a small amount of red blood. I wrote Diver Alert Network, and a doctor responded with this,

“These traces of blood could be the result of barotrauma squeezes at various levels, from your paranasal sinuses (more frequent) to the airway. While some alveoli and terminal bronchi are fairly collapsible, the trachea and the larger bronchi have a harder cartilaginous structure and are not as susceptible to collapse. While they are harder to collapse, the capillary bed underneath their epithelial lining is very vulnerable to the dramatic drop in relative barometric pressure imposed by freediving; traces of blood could indeed be the result of it.

If these were traces of blood and the result of an airway squeeze, it likely involved capillaries from the respiratory epithelium lining; in which case, it would probably heal in a few days. Damage to the cartilage rings would mean a different level of damage.”

I spoke with another doctor who indicated injuries to the cartilage rings would be quite painful, and injuries to alveoli would likely have produced some symptoms, so he suspects it was capillaries in the epithelial lining. From what I understand, symptoms can be deceiving. Some people show signs, and others do not. The same goes for blood; people say it is difficult to know exactly where the bleeding happened. The questions I have are:

1. What is your opinion as to where the injury occurred?

2. Is it normal for this type of damage to still be producing old blood for two weeks?

3. Would it be your conservative estimate for damage like this to heal from the date it occurred?

4. Can we tell how severe the injury was by the symptoms or amount of blood?

5. What is a possible reason that the blood came out delayed and not within some minutes after my dive?

Thank you for your time.

#

Hello,

Welcome to icliniq.com.

Thanks for asking your query here, and I suppose many of your questions are answered already. But still, I will try to make it simple to understand it.

So let us understand what is free diving first. Freediving is the technique of breath-holding diving technique and is harmful only after repetitive diving sessions.

Usually, it causes a series of pressure changes in the lungs and heart causing symptoms ranging from mild cough, dyspnea, blood-stained frothy (sometimes) expectoration to blackout, and lung squeeze.

This lung barotrauma can occur either during descent or ascent, and not a single mechanism but a combination of factors are involved in it. But in your case, it appears to be mild barotrauma as the symptoms were not aggressive and never became severe. So it could be just pulmonary edema and alveolar membrane rupture, causing alveolar hemorrhage during the ascending technique. This usually resolves within 24 hours and may take up to seven days to clear on a chest x-ray. But generally, these symptoms are usually transient and get cleared over a few days. And generally, there is no long-term damage as far as fitness is concerned. But individual variations may still occur, and we can not find out or relate exactly. So it would be advisable to be sure that it is not something serious but if symptoms still persist or aggravate, get medical help at earliest.

I hope it explains everything to you.

Thank you.

Hi doctor,

Thank you for your reply.

Have you had experience with other freediving injuries before? It seems like you know a bit about it. Generally x-rays will always be clear I was told the only real useful scan would be CT scan without contrast, but probably not worth the money. Thanks again for your response I will be sure to consult you again in the future and recommend you to others. There is a lots of confusion in the freediving community as to lung injuries the biggest being recovery times. I am very conservative with this one I will take a full month off diving where most people are recommending two to three weeks. The pressures are so great now and the risk of reinjuring weak tissue is very high one week makes little difference when compared to another injury. Thanks.

#

Hello,

Welcome back to icliniq.com.

Thanks for your response and appreciation.

Even though sports injuries related to freediving are not familiar, I have some knowledge about it as a chest specialist. Though I have not come across many cases, I can give details of the possible injuries while diving. All it depends upon how well you are trained and how long is your endurance. As I said earlier, if something goes wrong, it can cause serious problems ranging from mild cough, dyspnea to pneumothorax, pneumomediastinum, barotrauma, hemoptysis to unconsciousness, death, etc. Individual variability occurs based on your training. There is a lot to explain if we get into more details. I hope you will explore more before your next freediving session. All the best. Take care.

Is it alarming that it's been 17 days and I'm still producing phelgm with brown flecks in it? How long can this last for?
# Hello Andrew,
It's very surprising to hear that even after 17 days still phlegm contains brownish flecks.
Although it's not that alarming but if associated with other symptoms like cough orvfever, it is advisable to see your physician for clinical examination.
The possibility of of underlying upper respiratory tract infection like flu or sinusitis can be the reason.
Also, bronchitis needs to be ruled out.
Hence, it will be good to get examined by your physician and get advice regarding any blood test or X-ray.
Upon conclusion necessary treatment or antibiotics can be considered.
By that time, you can take OTC cough expectorant available locally.
Take care
There's no fever or cough. I've even using a pulse oximeter today but it's reading normal. I feel fine I might occasionally feel a mild pain in my chest just below my right nipple. It's very mild and not constant. I'll try to see physician soon I've been considering getting a CT scan done.

Thanks
Andrew
# Hello Andrew,
As I said earlier many things will get cleared after clinical examination.
It is good that you don't have cough or fever.
HRCT scan chest would be the appropriate to diagnose the underlying pathology.
Take care

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