Often referred to as cardiopulmonary DCS, this manifestation is rare and potentially fatal. The onset is usually early after diving and is more likely following a provocative profile (e.g. where decompression stops have been omitted for some reason). The diver may complain of cough and shortness of breath, which give rise to the colloquial name ‘the chokes’. There may also be retrosternal chest pain and a progression from confusion to loss of consciousness and collapse, the latter most likely reflecting rapidly progressive hypotension. Cardiac arrest and death may rapidly follow. Alternatively, the symptoms may spontaneously resolve; especially if oxygen breathing is quickly commenced because this almost certainly accelerates the resolution of VGE affecting the lungs. Because large numbers of VGE are required to produce pulmonary symptoms, it is not surprising that symptoms of involvement of other organs often accompany or follow pulmonary DCS. Thus, even if pulmonary symptoms begin to resolve, there should be a high index of suspicion for other manifestations.