Differential Diagnosis for Skin Marbling after Ascent from Diving
Single Most Likely Diagnosis
- Decompression Sickness (DCS): This condition, also known as "the bends," occurs when rapid changes in pressure cause gases dissolved in the bloodstream to form bubbles in the body. Skin marbling (cutis marmorata), headache, and vertigo are common symptoms of DCS, especially after diving. The presentation of these symptoms following a dive makes DCS the most likely diagnosis.
Other Likely Diagnoses
- Nitrogen Narcosis: While less likely given the specific symptoms of skin marbling, nitrogen narcosis can cause neurological symptoms such as vertigo and headache due to the anesthetic effect of nitrogen at high pressures. However, it typically occurs at greater depths and resolves upon ascent.
- Oxygen Toxicity: This condition can occur due to breathing high partial pressures of oxygen during diving, leading to neurological symptoms including vertigo and headache. However, skin marbling is not a typical presentation.
Do Not Miss Diagnoses
- Arterial Gas Embolism (AGE): Although less common than DCS, AGE is a life-threatening condition that can occur if gas bubbles enter the arterial circulation, potentially leading to severe neurological symptoms, including vertigo and headache. The presence of skin marbling could be indicative of gas bubbles in the skin, but AGE would typically present with more severe and immediate neurological deficits.
- Cardiac or Pulmonary Conditions: Conditions such as pulmonary embolism or acute coronary syndrome could potentially cause similar symptoms, especially if there's a pre-existing condition. While diving itself is a risk factor for certain cardiac conditions due to the physical exertion and pressure changes, these would be less directly related to the act of diving and the specific symptom of skin marbling.
Rare Diagnoses
- Inner Ear Decompression Sickness: A rare form of DCS that specifically affects the inner ear, leading to vertigo and potentially other neurological symptoms. Skin marbling would be an unusual presentation for this condition.
- High-Pressure Neurological Syndrome: This is a rare condition associated with deep diving, characterized by neurological symptoms. However, it is less likely given the symptoms described and the fact that it typically occurs at much greater depths than those that would cause DCS with skin marbling.
Given the symptoms of skin marbling, headache, and vertigo following a dive, the immediate next steps in treatment should focus on Decompression Sickness (DCS), with prompt administration of oxygen and arrangements for emergency medical evacuation to a hyperbaric treatment facility if available.