Purpose To present a case report involving a rare case of a scuba diver presenting with portal venous gas (PVG) from decompression sickness (DCS).Methods Patient records were reviewed for clinical presentation, imaging findings, treatment course, and symptomatic resolution. A literature review was conducted to provide support for the case and provide background information for the unique presentation.Results We present a case of PVG secondary to DCS in an experienced scuba diver after repeated dives to depths greater than 150 meters. Patient presented with nausea, vomiting, confusion, nystagmus, ataxia, and a rash on the upper chest and back. After PVG was identified on CT, hyperbaric oxygen therapy was initiated. Symptoms resolved within the span of 3 days.Conclusion PVG is a rare and easily treatable phenomenon in DCS. It is important to identify the etiology of the PVG in the case of DCS to enact appropriate treatment.