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[Wide-spread subcutaneous emphysema after third molar extraction. Case report].

Two days after wisdom teeth removal an eighteen-year-old man complained of a painful subcutaneous neck emphysema. CT scans showed that the air collections were expanding close to the mediastinum. A conservative intravenous medication with broadspectrum antibiotics was administered and within three days the symptoms resolved completely without any surgical intervention. Subcutaneous emphysema after dental treatment can develop into infectious, potentially lethal fasciitis and mediastinitis. Therefore it must be thoroughly examined and immediately operated on, if suspicious of an infection.

Adolescent↗

A case of factitious subcutaneous emphysema.

A 13-year-old girl presented with a 2-month history of recurrent soft tissue swelling of her right upper extremity. Dermatological examination revealed soft tissue crepitation and a small ulcer on the dorsum of her right hand. After several investigations including radiographic and systemic blood tests the diagnosis of factitious subcutaneous emphysema was made and the patient was referred to psychiatry for proper management.

Adolescent↗

Late onset of subcutaneous emphysema and hypercarbia following laparoscopic cholecystectomy.

Laparoscopic surgical techniques are increasingly being applied to treat intraperitoneal abnormalities. These minimally invasive techniques potentially offer decreased operation time, decreased morbidity, and decreased length of hospitalization stays. These procedures, however are not without potential morbidity. Herein we describe two patients treated with laparoseopic cholecystectomy whose cases were complicated with subcutaneous emphysema and hyperearbia without pneumothorax. In each of these cases, carbon dioxide gas was used to induce pneumoperitoneum. In one of the cases, the hypercarbia was a late event occurring during the surgery, and in the second case, the first such description in the literature (to our knowledge), hypercarbia developed after termination of the induced pneumoperitoneum.

Aged↗

Massive subcutaneous emphysema after thoracoscopic argon beamer use for pleurodesis.

Argon beamer coagulation (ABC) has been effectively used in a wide variety of thoracoscopic and laparoscopic procedures. However, stringent safety measures have to be taken to prevent potentially severe complications due to overpressurization. Here we report a case of thoracoscopic pleurodesis with talcum powder during which the use of an argon beamer led to severe subcutaneous emphysema involving the trunk, upper extremities, neck, and face. Literature on complications secondary to the use of ABC in closed body cavities is reviewed.

Aged↗

[Postoperative intensive care of a patient with Cushing's syndrome accompanied with retroperitoneal abscess and massive subcutaneous emphysema].

A 60-year-old woman with Cushing's syndrome due to right adreno-cortical adenoma was referred to us because retroperitoneal abscess was found during surgical removal of the right adrenal gland. The diagnosis of Cushing's syndrome was made on the basis of elevated serum levels of cortisol. The abscess was accompanied with massive subcutaneous emphysema and pneumomediastinum. After operation the patient was admitted to ICU in the Medical Center for Emergency and Critical Care. PMX-DHP, continuous hemodiafiltration, and drainage were performed, and antibiotics were given. Nine days after the admission the patient recovered generally, and was transfferd to the Department of Urology. It was demonstrated that an opportunistic infection must be always considered in the condition like the present case.

Abscess↗

[Capnothorax and subcutaneous emphysema in attempted laparoscopic suture of duodenal ulcer].

A 72-year old lady suffering from coronary heart disease was admitted with acute abdominal pain. Laparoscopy was performed and revealed perforation of a duodenal ulcer. The surgeon decided to suture the perforation via laparoscope. After an uncomplicated start he had to finish the laparoscopic procedure because of a massive hypercapnia and a developing subcutaneous emphysema. Laparotomy showed an iatrogenic perforation of the right diaphragm. A chest drain was inserted; after suturing of the perforated ulcer the abdomen was closed. The further hospital stay was uneventful. The possible causes for the increasing hypercapnia are discussed. We suggest close monitoring of patients during laparoscopy including capnometry and the anaesthesist should be aware of rare complications.

Aged↗

Mediastinal and subcutaneous emphysema associated with childhood measles.

An analysis of the clinical records and chest radiographs of seventeen children with subcutaneous and mediastinal emphysema (SCME) complicating childhood measles was made. The commonest sites of extra-alveolar air were the retrosternal space (16/17) and paraspinal (12/17). Other areas were within the inferior pulmonary ligament (7/17) and subpulmonary areas (6/17). All patients had pulmonary infiltrates. There was pneumothorax in 30% of cases. Eighty per cent of children showed subcutaneous emphysema in addition to mediastinal emphysema. There was a mortality of 12%. SCME completely resolved within 14 days in the remaining patients.

Child, Preschool↗

[Postoperative mediastinal and subcutaneous emphysema after intubation narcosis].

The case of a 16-year old female is presented who underwent laparoscopy under general anaesthesia and uncomplicated endotracheal intubation. Four hours after uneventful anaesthesia and extubation the patient started vomiting and coughing. Subcutaneous tissue emphysema developed and pneumomediastinum was diagnosed on a chest roentgenogram. A small lesion in the posterior wall of the trachea and consequent upon intubation by indirect tracheoscopy was identified as the possible source of air entry on the third postoperative day. Air accumulation and tracheal lesion protractedly responded to antitussive and antibiotic medication. A tracheal lesion during intubation is the most frequent and thus the most probable cause of air accumulation presenting as pneumomediastinum, pneumothorax or subcutaneous emphysema. As in the present case, increased airway pressure from vomiting or coughing even after a latent period may induce the phenomenon. Very occasional reports on spontaneous pneumomediastinum in young individuals must not detract the circumstances of endotracheal intubation from suspecting an iatrogenic lesion, confirming it by immediate endoscopy and thereupon deciding on conservative or surgical treatment.

Adolescent↗

Subcutaneous emphysema, pneumomediastinum, and pulmonary emphysema in a young schipperke.

A 4-month-old, intact female schipperke was presented for evaluation and treatment of subcutaneous (SC) emphysema. Radiographs revealed pneumomediastinum and SC emphysema. Sequential radiographs confirmed a worsening of the SC emphysema. Extensive, nonsurgical evaluation failed to reveal the source of the air within the mediastinum. Exploratory thoracotomy revealed an emphysematous right middle lung lobe. Lobectomy of the right middle lung lobe resolved both the pneumomediastinum and SC emphysema. Histopathological evaluation confirmed pulmonary emphysema. A variation of congenital pulmonary emphysema was considered in this case.

Animals↗

[Retroperitoneal, mediastinal and subcutaneous emphysema with pneumothorax after colonoscopy].

HISTORY: Severe ulcerative colitis had been diagnosed in a 25-year-old man six years ago. That same year he underwent laparoscopy for mechanical ileus. Since then he has been on a maintenance dose of sulphasalazine without any further symptoms. Because of a known pseudopolyposis coli, repeat coloscopy was performed. EXAMINATIONS AND FINDINGS: The endoscope was smoothly introduced and the examination was without pain. No premedication had been given. A biopsy was obtained during withdrawal of the endoscope. Suddenly the patient noticed marked scrotal swelling. The examination was terminated abruptly. No lesions of the wall of the distal colon were seen when the endoscope was pulled out immediately. Quickly, cutaneous emphysema developed over the right side of the abdomen and thorax up to the neck. The patient could no more properly hear his own voice. Radiology demonstrated bilateral pneumoretroperitoneum, mediastinal emphysema and pneumothorax. TREATMENT AND COURSE: The patient was put on parenteral nutrition for 4 days and prophylactically received amoxycillin, calvulanic acid and metronidazole. The air was gradually absorbed and the patient discharged symptom-free after 7 days. CONCLUSION: In contrast to intraperitoneal perforation, which usually causes acute symptoms of peritonitis and requires urgent surgical treatment, the course of the much rarer retroperitoneal perforation is more benign with few symptoms and can be managed conservatively.

Adult↗