Pulmonary hemorrhage resulting from roller coaster
Case Report
Pulmonary hemorrhage resulting from roller coaster Abstract
Roller coasters are probably one of the more popular rides at amusement parks around the world, and there are few reported injuries. We report a case of symmetric diffuse upper lobe hemorrhage resulting from roller coaster in a previously healthy woman. The clinical course, manage- ment, and etiology of her case are discussed; and the literature is reviewed. To our knowledge, pulmonary hemorrhage in this setting has not yet been described.
Pulmonary hemorrhage is a relatively common compli- cation of blunt chest trauma. Occasionally, it may result from pulmonary barotrauma after scuba diving or from sports activities not associated with barotrauma such as long-breath-hold diving [1,2]. We examined a 40-year-old woman with acute hemoptysis after a Roller coaster ride. To our knowledge, this is the first reported case of pulmonary parenchymal hemorrhage associated with a roller coaster ride.
The patient, a 40-year-old woman, took a giant roller
coaster ride at a local amusement park. She experienced a brief episode of chest pain during one descent in 2-minute riding. When getting off the roller coaster, she expectorated an estimated 150 mL of fresh blood. Subsequently, she complained of palpitations and dyspnea.
When she arrived at our hospital emergency department with her family 2 hours later, she still had hemoptysis. Her medical history was unremarkable. There was no suggestion of current or recent respiratory tract infection by either physical examination or history.
Physical examination found that she was nervous; and her heart rate was 110, respiratory rate was 30, and blood pressure was 140/95 mm Hg. Oxygen saturation was 90% to 95% on room air. On 3-L/min nasal cannula, her PaO2 was 98 mm Hg. Laboratory blood examination showed normal coagulation, and hematologic studies found mild increase in total bilirubin (34.2 umol/L) and direct bilirubin (11.6 u/L). High-resolution computed tomography revealed symmet- ric bilateral upper and middle lobe ground glass opacities and minimal interlobular septal thickening (Figs. 1 and 2).
Although some peripheral sparing was present, the ground glass appearance extended to the extreme apical lung areas. The patient was started on a course of methylprednisolone (40 mg/d) for 3 days, and she had no further hemoptysis. The dose of steroids was changed to prednisone 5mg/d for 5 days.
Follow-up chest radiograph, at 7 days, demonstrated complete resolution of the abnormalities.
Roller coasters are one of the most popular rides at amusement parks around the world. The United States Consumer Product Safety Commission provides data on fatalities and hospital emergency department-treated injuries associated with amusement rides and inflatable attractions. From 1987 to 1999, fatalities averaged 4.5 a year [3].
There is limited literature on the actual or specific Physiologic effects of roller coaster rides on the human body, although similar effects can be inferred from the aeronautical literature on acceleration [4,5]. Otherwise, since 1979, there have been several medical case reports of apparently healthy individuals suffering neurologic injury from high-speed, high-G-force rides [6-9]; but no research has determined the G-force threshold for human brain injuries [10].
To our knowledge, this is the first case report document- ing that riding on a roller coaster may be a precipitating factor for acute hemoptysis.
Roller coaster rides create ”up-and-down, to-and-fro” and rotational acceleration, which produces tensile and shearing stresses.
A double-loop corkscrew roller coaster can impart an acceleration force on the human body that has been estimated to be approximately 2.5 to 3.0 G on average during a 94- second ride [9].
Sport-related hemorrhage in patients without underlying lung disease has been reported in scuba diving and long- breath-hold diving [11,12].
The most common proposed mechanism is a multifactorial transient increase in pulmonary capillary pressure leading to capillary endothelial disruption (”stress failure hemorrhage”). In some cases of scuba-diving-related hemorrhage, baro- trauma-induced alveolar rupture has also been suggested.
There are 2 case reports that share the similar pathoge- nicity. One is pulmonary hemorrhage caused by bungee jumping [1], and the other is pneumothorax after a roller coaster ride [13].
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Fig. 1 Computed tomographic image shows the upper lobe bilateral symmetric ground glass opacity with minimal interlobular septal thickening.
In our case, the symmetric upper and middle lobe hemorrhage likely reflects the head-down position in the roller coaster that affected pulmonary blood flow distribu- tion. The pulmonary capillary volume in the upper and middle lobes is increased, as is pulmonary venous pressure. An acute increase in upper body intravenous volume and pressure, accompanying the rapid deceleration and reverse
Fig. 2 Computed tomographic emphasizes the middle lobe consolidation that was compared by interlobar fissure.
acceleration forces in the head-down position, has been proposed as the mechanism for intracerebral hemorrhage. Similarly, the timing of the chest pain in the current case also implies that the injury occurred during descent. Valsalva maneuvers and breath-holding during the downward phase may also be contributing factors.
Given the growing popularity of roller coasters, this complication and its unusual imaging pattern may be seen with increased frequency.
On the basis of medical reports of Neurologic injuries on roller coasters, some legislators have proposed limiting the G-force levels of roller coasters to less than 4 G. Germany has adopted similar legislation, limiting their roller coasters to 5 G [10].
Through efforts spearheaded by Rep Edward Markey of Massachusetts, the US Congress is turning its attention to roller coaster safety; and legislation is being proposed to regulate G-forces induced by roller coaster rides [10].
Unfortunately, new technological advances and compe- tition within the amusement industry have led to dangerously high-G-force rides that may (and will) produce bodily harm.
Riders should also be aware that, although the current risk of amusement park injury is very low, injuries and fatalities do occur. Roller coaster riding, associated with high velocities and extreme acceleration/deceleration forces, could be a modern cause of hemoptysis and lung injuries.
Ming Yin MD
Emergency Department Chinese People’s Liberation Army General Hospital
Beijing 100853, China E-mail addresses: [email protected]
Qing Tian MD
Department of Respiratory Diseases Chinese People’s Liberation Army General Hospital
Beijing 100853, China
Hong Shen MD
Emergency Department Chinese People’s Liberation Army General Hospital
Beijing 100853, China
doi:10.1016/j.ajem.2010.03.023
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