Abstract

Incidental peripheral reticulation in a high-frequency recreational diver

Taylor Britton CCMA, Andres Felipe Yepes Hurtado MD

Corresponding author: Taylor Britton
Contact Information: Taylorbritton459@gmail.com
DOI: 10.12746/swjm.v14i61.1683

ABSTRACT

Pulmonary barotrauma is a recognized complication of scuba diving, but the long-term pulmonary effects of repetitive subclinical pressure-related injury remain poorly understood. We report a 60-year-old male never-smoker with extensive recreational diving exposure (150–175 dives annually) who was referred for evaluation of incidentally discovered pulmonary nodules and peripheral reticulation on computed tomography (CT). The patient remained asymptomatic with preserved exercise tolerance and an unremarkable pulmonary examination. CT imaging demonstrated mild bilateral peripheral reticulation with subpleural predominance and stable pulmonary nodules without honeycombing, traction bronchiectasis, pleural effusion, or pneumothorax. Although causality cannot be established, chronic repetitive micro-barotrauma represents a biologically plausible mechanism. This case highlights the need for further investigation into the long-term pulmonary consequences of frequent scuba diving exposure.

Keywords: Scuba diving, pulmonary barotrauma, interstitial lung abnormality, peripheral reticulation, computed tomography

INTRODUCTION

Acute pulmonary barotrauma is a recognized complication of scuba diving and may manifest as pneumothorax, pneumomediastinum, or arterial gas embolism.1–4 Alveolar rupture resulting in air dissection along bronchovascular sheaths, commonly referred to as the Macklin effect, has been proposed as a mechanism of pressure-related pulmonary injury.6 Chronic radiographic manifestations associated with repetitive pressure exposure remain incompletely characterized.

CASE PRESENTATION

A 60-year-old male lifelong non-smoker was referred for pulmonary evaluation after incidental pulmonary nodules were identified. He reported approximately 150–175 scuba dives annually over many years. The patient denied dyspnea, chest pain, cough, hemoptysis, weight loss, or exercise limitation. Prior military service included possible asbestos and jet fuel exposure. Physical examination was unremarkable.

IMAGING FINDINGS

CT imaging demonstrated stable pulmonary nodules measuring up to 7 mm and mild bilateral peripheral reticulation with subpleural predominance. No honeycombing, traction bronchiectasis, pleural effusion, or pneumothorax was identified. Interstitial lung abnormalities detected incidentally on CT have emerged as an important area of investigation because of their association with progression to clinically significant fibrotic lung disease.7–10

DISCUSSION

Previous investigations have primarily focused on acute pulmonary complications of diving, including pneumothorax, pneumomediastinum, and arterial gas embolism.1–5 While pulmonary function abnormalities have been reported in some professional divers, radiographic evidence of chronic interstitial remodeling remains poorly characterized.11–12

Figure 1

Figure 1. Upper thoracic axial CT image demonstrating mild peripheral reticular interstitial opacities without focal consolidation.

The patient described in this report participated in approximately 150 to 175 dives annually, representing substantially greater exposure than most recreational divers. Although asymptomatic, CT imaging demonstrated mild bilateral peripheral reticulation with a subpleural distribution. These findings raise the possibility that repetitive microscopic alveolar injury may contribute to chronic interstitial remodeling in susceptible individuals.

Figure 2

Figure 2. Mid-thoracic axial CT image showing bilateral subpleural reticulation within the peripheral lung fields.

Figure 3

Figure 3. Lower thoracic axial CT image demonstrating persistent bilateral peripheral reticular changes without traction bronchiectasis.

Figure 4

Figure 4. Basilar axial CT image showing mild dependent and subpleural reticulation without honeycombing.

Figure 5

Figure 5. Lung base image demonstrating subtle bilateral peripheral interstitial abnormalities.

Alternative explanations must also be considered. The patient reported prior military service with possible asbestos and jet fuel exposure. Remote inflammatory or infectious processes may produce similar radiographic findings. The absence of honeycombing, traction bronchiectasis, or significant pulmonary symptoms argues against advanced fibrotic lung disease. Accordingly, this report does not establish causality but instead highlights a clinical observation deserving further investigation.

Figure 6

Figure 6. Lowest axial section demonstrating persistence of mild reticular changes at the lung bases.

Future studies incorporating high-resolution CT, pulmonary function testing, diffusion capacity measurements, and longitudinal follow-up of highly exposed divers may help clarify whether repetitive pressure-related injury contributes to subtle interstitial lung abnormalities.

CONCLUSION

This case describes mild peripheral reticulation identified in an asymptomatic high-frequency recreational diver. Chronic micro-barotrauma remains a plausible explanation, although additional longitudinal imaging and pulmonary function testing are required. Further study is needed to better understand the long-term pulmonary effects of repetitive diving exposure.


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Article citation: Britton T, Yepes-Hurtado AF. Incidental peripheral reticulation in a high-frequency recreational diver. The Southwest Journal of Medicine. 2026;14(61):94–97
From: Christus Trinity Mother Frances Health System, Tyler, TX (TB, AFYH)
Conflicts of interest: none
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