Decompression Illness Presenting as Breast Pain

Scottish researchers recently treated two women in whom the initial symptoms were breast pain and neither woman associated the pain with DCS. The researchers, who had not seen similar cases in more than 200 cases of DCS, postulate that breast pain may be an under-recognized manifestation of DCS.

Breast pain presented in a 34-year-old female 90 minutes after completing a 32-minute dive to 39 meters; she made two decompression stops on the way up. The pain failed to resolve and was followed by pain in the right shoulder. After successful chamber treatment, she recalled two previous episodes in which she had severe breast pain after completing non-decompression dives, attributing her symptoms to the physical restriction of her dry suit or clambering into the dive boat. Once the pain had been so severe that she was unable to tolerate a car seat belt during the drive back from a dive.

An hour after a 29-year-old female completed her third dive in two days, she developed breast discomfort so severe that she was unable to tolerate her bra. She was given oxygen on the dive boat, and she was treated successfully in a chamber for DCS.

Both women were diving in their usual dry suits. Both received what might be regarded as undeserved decompression illness despite unremarkable dives with appropriate decompression stops. Both were subsequently shown to have significant patent foramen ovale, which is associated with an increased risk of decompression illness. It is impossible to prove that the breast symptoms were definitely due to DCS; however, nitrogen bubbles may have caused lymphatic obstruction in breast tissue, or the constriction of breast tissue in a tight dry suit, by restricting lymph flow, might make this presentation likely.

Undersea and Hyberbaric Medical Journal 2(106, Vol. 33, Nn, 2) “Decompression illness presenting as breast pain.” A.J. Trevetti, C. Sheehan, R. Forbes, Orkney Hyperbaric Chamber, Orkney, Scotland.