Air pockets in chest § risk of flying

[elr10]

A few weeks ago my boyfriend suffered from Acute Mountain Sickness while trekking in a romote region of Western China. After about 24 hours in critical condition in a rural Chinese hospital he was evacuated by jet to a hospital in Hong Kong where he was diagnosed with AMS and both pulmonary & cerebral oedema. With great medical care in HK, he has recovered quite quickly. The one remaining issue that lingers is that he has pockets of air trapped in his chest that were caused by a tear in his trachea that ocurred when they intubated him in China after he stopped breathing. His doctors in Hong Kong have said that while these pockets remain, flying poses a serious risk because planes are only pressurized to ~5000 ft. and the air pockets would expand at altitude. They have said that he should wait to fly for 2 weeks after the air pockets are gone but that chest x-rays cannot show conclusively whether air pockets remain & so the risk is somewhat uncertain. He is now terrified to fly & has asked me to try to get a 2nd opinion from a doctor in the States. Given his condition, can anyone advise on how long he should wait to fly after the air pockets do not show up on x-rays? How great is the risk of flying and what is the specific nature of the risk? Finally, what would the warning signs that something is going wrong mid-flight be and what measures could he take?

Many thanks for any insight you can provide.

All best,
Elizabeth

elizabethlauren_richards***@****

[National Jewish]

It sounds like your boyfriend got very good medical care.  I would continue to rely on the judgment of the doctors who are caring for him as to when he can fly safely.  I agree that he should not fly as long as any air pockets are visible on chest x-ray.  Another name for these air pockets is subcutaneous emphysema.  He should only fly after the subcutaneous emphysema has been gone for at least two weeks.  The longer he can wait, the better.

It should also be determined, to the best of the doctors’ ability, if the tear in his trachea has healed.  This may require direct examination and special x-rays to confirm that the tracheal wall is intact.

Plain chest x-rays cannot conclusively show if the subcutaneous emphysema is present.  However, if this is not seen, the air has probably been resorbed.  Since a CT scan of the lungs shows more detail than a chest x-ray, it would be more helpful in seeing if air is still trapped in his chest.  Also a CT scan will show if the tear in his trachea has healed.

The subcutaneous emphysema would also be a sign that the tear in his trachea has not healed, that air is still leaking into his chest, and that he should not fly.  In any event, he should not fly until "cleared to fly" by at least two doctors who specialize in treating lung problems.  The risk that the air pockets would expand at altitude is too great to do otherwise.

[joopoo]

A related discussion, emphysema information was started.