Fatal Pulmonary Barotrauma from a Commercial Flight.

Background: There is a paucity of cases of fatal pulmonary barotrauma in the literature unless the patient is mechanically ventilated. Here we report a presumed pulmonary barotrauma caused by pulmonary cyst rupture as barometric pressure reduced during a commercial flight, with tragic consequences.

Case report: A 71-yr-old woman with a history of a large pulmonary cyst lost consciousness on a commercial domestic flight (1.15-h flight time). This period of reduced level of consciousness was undetected and may have caused hypoxic brain injury. Subsequent hospital investigations revealed a large cavitating lesion in the left lung and free gas in the brain, suggestive of pulmonary barotrauma and cerebral arterial gas embolism. Progression of the hypoxic brain injury caused death.

Discussion: The likely cause of death was speculated to be caused by the preexisting pulmonary cyst, which was ruptured by either Valsalva, cough suppression, change in barometric pressure, or a combination of all three, causing fatal air emboli. Stevens G. Fatal pulmonary barotrauma from a commercial flight. Aerosp Med Hum Perform. 2025; 96(2):180-182.