Tracheal rupture resulting in life-threatening subcutaneous emphysema

We present a case of a patient with severe chronic obstructive pulmonary disease who developed dramatic mediastinal and subcutaneous emphysema, without pneumothorax, following a difficult intubation. Misdiagnosis of tracheal rupture as barotrauma from alveolar overdistention initially delayed intervention and caused persistence of subcutaneous emphysema. Despite efforts to minimize tidal volume and airway pressure, the large airway disruption and positive-pressure ventilation resulted in tension subcutaneous emphysema with near-fatal hemodynamic compromise, oliguria, and respiratory acidosis. Decompression with subcutaneous vents immediately reversed the life-threatening circulatory and respiratory compromise and stabilized the patient until surgical correction of the tracheal tear could be accomplished.     

Is air an issue? A severe case of subcutaneous emphysema in an immunocompromised patient

Abdominal crepitus and air in the subcutaneous tissue should be recognized early, as the most common etiologies for subcutaneous emphysema are fatal if not treated acutely. We present the case of a patient who developed subcutaneous emphysema as a consequence of the dehiscence of a previously closed gastrocutaneous fistula.     

Traumatic occurrence of chest wall tamponade secondary to subcutaneous emphysema

Subcutaneous emphysema is a physical finding that itself is usually perceived as benign yet rarely may, in and of itself, be life-threatening. We present an unusual case of a 67-year-old woman who developed delayed severe subcutaneous emphysema and tension pneumothorax from a rib fracture subsequent to a fall. We review the pathophysiology, manifestations and management options of this disorder. In patients whose clinical condition allows it, chest tube placement prior to intubation should be considered. Furthermore, positive end-expiratory pressure should be minimized. We present a case that illustrates how subcutaneous emphysema itself can be a potential cause of respiratory failure and tamponade physiology. In our case, a patient with traumatic subcutaneous emphysema developed respiratory failure and clinical deterioration after the introduction of positive pressure ventilation. In such rare scenarios, care should be taken to consider the absolute need for positive pressure ventilation without surgical decompression.     

Subcutaneous emphysema of the abdominal wall from diverticulitis with necrotizing fasciitis

The case history of a patient with subcutaneous emphysema of the abdomen from sigmoid diverticulitis is presented. The mechanisms for developing abdominal wall emphysema are reviewed. Thus when the gas originates from the gastrointestinal tract, mechanical factors are mainly responsible for this phenomenon. These include a direct communication through a colonocutaneous fistula. Gas may, however, also be spread into the abdominal wall by high intraintestinal pressures. Infection with gas-producing organisms may be associated with subcutaneous emphysema. This is particularly true when the emphysema develops 48 h or longer after onset of symptoms. Infection, however, is not the major cause for gas in these tissues.     

Extensive surgical emphysema following restorative dental treatment

We present a patient with extensive surgical emphysema following the dental restoration the upper left first molar (tooth 26) with a high speed turbine handpiece. The clinical findings and management of subcutaneous cervical emphysema are discussed.     

Upper airway obstruction caused by massive subcutaneous emphysema

Acute upper airway obstruction is a potentially life-threatening event. The most common causes include foreign body inhalation, thermal injury, inflammation, angioedema and trauma. Airway obstruction caused by submucosal extension of subcutaneous emphysema has only been previously reported once. We report the case of a patient who suffered a respiratory arrest as a result of hypopharyngeal and laryngeal swelling associated with massive subcutaneous emphysema.     

A unique case of Munchausen's syndrome

A most unusual case of Munchausen's syndrome in an 18-year-old Yemeni female is described. The patient presented with bleeding from various sites; repeated subcutaneous emphysema of the face, orbit and upper chest; ulcers on the tongue, and dermatitis autogenica. The illness was confirmed to be factitious and self-induced when she was caught red-handed trying to inject air. We believe this to be the first report of a case where all these features occurred concurrently and only the second report where a patient developed self-induced orbital emphysema.     

Subcutaneous carbon dioxide emphysema following laparoscopic salpingo-oophorectomy: a case report

Multiple patient and economic benefits have contributed to the widespread popularity of laparoscopic surgery. Although the laparoscopic approach is safe, it is not without potential complications. The following case study describes a patient undergoing a laparoscopic salpingo-oophorectomy who had a sudden rise in end-tidal carbon dioxide to 65 mm Hg and was found to have developed subcutaneous emphysema. Hyperventilation, close monitoring, and mechanical ventilation for 4 hours postoperatively resulted in a positive patient outcome. The mechanisms of carbon dioxide absorption, as well as risk factors, complications, treatment, and prevention of subcutaneous emphysema will be described.     

Subcutaneous emphysema in advanced cancer

Spontaneous subcutaneous emphysema is a rare and usually benign entity that may occasionally be symptomatic. We report a case of a patient with advanced cancer who developed extensive but asymptomatic subcutaneous emphysema shortly before death. Perforation of the lower gastrointestinal tract, perhaps as a result of straining due to severe unrelieved constipation or due to fistula formation, is suspected to have been the mechanism. The causes, treatment, and implications for management of this condition are discussed.     

Idiopathic adult intussusception

This is the case of a patient with a history of blunt chest trauma associated with subcutaneous emphysema and pneumothorax. The patient complained of inspiratory stridor on presentation. Anatomical relationships can explain the pathophysiological process.     

Intracranial hypertension secondary to tension subcutaneous emphysema

A patient with severe closed head injury and tension subcutaneous emphysema developed intracranial hypertension unresponsive to conventional treatment. Subcutaneous air drainage controlled the intracranial pressure. The subcutaneous pressure was directly correlated with intracranial pressure.     

Massive subcutaneous emphysema and hypercarbia: complications of carbon dioxide absorption during extraperitoneal and intraperitoneal laparoscopic surgery--case studies

The laparoscopic approach to surgery is being used with greater frequency as our healthcare system continues to strive for shorter hospital stays and improved postoperative patient recovery times. However, laparoscopy is not without potential complications. This article presents 2 patient case studies. The cases differ in surgical technique. One patient's laparoscopic surgery involved an extraperitoneal approach. The second patient's surgery involved an intraperitoneal approach. Massive subcutaneous emphysema developed in both patients. The phenomenon of subcutaneous emphysema associated with laparoscopic surgery will be defined and discussed.     

胸腔镜下肺部手术后发生广泛皮下气肿的临床分析

目的 探讨胸腔镜下肺部手术后发生广泛皮下气肿的影响因素.方法 回顾性分析2015年10月-2020年10月3314例行胸腔镜下肺部手术后发生广泛皮下气肿患者的临床资料,寻找发生广泛皮下气肿的相关因素,分析皮下气肿的治疗效果.结果 术后广泛皮下气肿发生率为1.90％(63/3314).其中,肺减容、胸腔粘连、合并肺气肿和...     

Concurrent Spontaneous Pneumomediastinum and Pneumorrhachis

Background

Spontaneous pneumomediastinum with concurrent pneumorrhachis (air in the spinal canal) and subcutaneous emphysema can be an alarming presentation, both clinically and radiographically. These clinical entities often require only conservative measures after ruling out any worrisome underlying causes. Management often involves appropriate imaging, hospital admission, and sub-specialty consultation as needed to help determine any potential causes for the presentation that may require anything more than a period of medical observation.

Subcutaneous emphysema and pneumomediastinum after dental extraction

Pneumomediastinum, pneumothorax, and subcutaneous emphysema can occur occasionally after a surgical procedure. Facial swelling is a common complication of dental management. The occurrence of subcutaneous emphysema, pneumothorax, and pneumomediastinum after dental procedures is rare. We present a case with subcutaneous emphysema of the upper chest, neck, chin, and pneumomediastinum after a tooth extraction and discuss the possible mechanism of subcutaneous emphysema. To prevent these complications during dental procedures, dental hand pieces that have air coolant and turbines that exhaust air in the surgical field should not be used.     

Fifty-year-old female with facial subcutaneous emphysema: a case report

Subcutaneous emphysema in itself is a benign condition. However, when present secondary to trauma, it may indicate a more serious problem. We report a patient with subcutaneous emphysema secondary to trauma sustained during a generalized seizure. It is believed that the source of the air in the tissue was from a minor laceration below and into the patient's nose without any fracture of the underlying bones or sinus involvement.     

Management of Significant and Widespread,Acute Subcutaneous Emphysema: Should We Manage Surgically or Conservatively?

Background

Subcutaneous emphysema of a limb after acute injury is classically associated with gas gangrene. Delayed management can result in amputation and death. Typically caused by a clostridial infection, patients are unwell, with rapidly spreading clinical signs, abnormal laboratory results, and cultures positive. There are reports of widespread subcutaneous emphysema of a limb in well-appearing patients, with blood parameters within normal limits; however, the optimum management of this type of case is unclear.

Objective

Our objectives were to present 4 new cases of acute subcutaneous emphysema in well-appearing patients managed with early surgery, review the literature, and discuss the management decisions in cases of acute subcutaneous emphysema in clinically well patients.

Case reports

Here we present a case series of 4 patients, all with penetrating injuries to the upper limb resulting in widespread subcutaneous emphysema within 24 h of injury. Mean age was 33 years. All were fit and well, with the exception of one with type 1 diabetes, no cardiorespiratory compromise, and no significant derangement of laboratory investigations. X-ray studies showed widespread gas within the soft tissues. All were treated aggressively with immediate surgical fasciotomy of the upper limb, thorough debridement, and washout as required. Gram stains revealed pus cells (polymorphonuclear leucocytes) in all, but organisms in only one case (Gram-positive cocci and bacilli). Prolonged culture grew organisms in all. All patients had a second washout and closure plus 6 weeks of antibiotics. All survived and had fully functioning limbs. Why should an emergency physician be aware of this? We recommend having a low threshold for rapid referral to an appropriate surgical speciality, allowing prompt and radical surgical management of this type of presentation, even in the presence of a well patient.     

A Case of Spontaneous Extracranial Epidural Emphysema

Objective

To report a rare case of spontaneous extracranial epidural emphysema.

Clinical Presentation and Intervention

An 18-year-old woman with a recent diagnosis of squamous cell carcinoma of the esophagus presented with acute onset of cough, dyspnea and subcutaneous emphysema. An esophageal endoscopy revealed an ulcerative lesion in the upper third of the esophagus that was diagnosed as squamous cell carcinoma. A computed tomographic scan of the chest showed spinal epidural emphysema in addition to pneumomediastinum and pneumoperitoneum. A few days later, the patient died of aspiration pneumonia and persistent epidural emphysema.

Conclusion

The spontaneous extracranial epidural emphysema in our case resulted from a bout of cough with tracking of air from the pneumomediastinum through the emaciated tissue planes into the epidural space.Key Words: Epidural emphysema, Spontaneous extracranial epidural emphysema, Subcutaneous emphysema     

Pneumothorax and subcutaneous emphysema complicating endotracheal intubation

We report subcutaneous emphysema and pneumothorax as immediate complications of endotracheal intubation in a patient with diffuse interstitial lung disease. We postulate increased intra-alveolar pressure during intubation leading to rupture of a subpleural bleb or cyst as a possible mechanism causing these complications.     

Spontaneous pneumomediastinum.

Spontaneous pneumomediastinum, or Hamman's syndrome, is a rare condition which may present with the symptoms of chest pain, dyspnoea, dysphagia, or neck pain. The signs of subcutaneous emphysema and Hamman's crunch (the presence of a crepitance sound that varies with the heartbeat on auscultation of the precordium) are usually present. A case of this syndrome occurring in an elderly patient with none of the recognised risk factors is presented.