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Subcutaneous emphysema often presents a management dilemma. Rarely, subcutaneous emphysema has pathophysiologic consequences. More often, it is extremely uncomfortable for the patient, and is often disfiguring and alarming for patients and family. When subcutaneous emphysema is severe, physicians may feel compelled to treat it, but the currently described techniques are often invasive or ineffective. We describe the use of an easily constructed, minimally invasive, fenestrated catheter that relieves the symptoms of subcutaneous emphysema.
Subcutaneous emphysema rarely causes significant adverse clinical consequences. Two patients had development of massive subcutaneous emphysema during positive-pressure ventilation that resulted in chest wall compression and respiratory failure. Drainage of the subcutaneous air produced dramatic improvement. Subcutaneous emphysema is potentially fatal in ventilated patients. Specific decompression of subcutaneous tissues is indicated in such extreme cases.
Subcutaneous emphysema is most often associated with thoracic pathology. The case is presented of a middle-aged woman with shock, abdominal distention and rigidity, and subcutaneous emphysema which resulted from a spontaneous gastric rupture. Subcutaneous emphysema has a variety of origins, including infections and rents in the respiratory tract, gastrointestinal tract, and the skin.
Subcutaneous emphysema is an unusual complication of bronchiolitis. The investigators describe a patient with bronchiolitis who developed extensive subcutaneous emphysema. Despite an alarming appearance, the patient recovered with symptomatic care and observation. Review of the literature shows a multitude of causes of subcutaneous emphysema. The vast majority of cases resolve without intervention.
Subcutaneous emphysema is a frequent complication of thoracic and cardiac surgical procedures, and emergency tracheostomy is often advocated as the treatment for this complication. However, we report the case of a patient in whom massive subcutaneous emphysema, which had developed after emergent replacement of the aortic root, was relieved using subcutaneous drains and suction, instead of a tracheostomy. We found that the subcutaneous drains provided effective decompression of the head and neck areas, and markedly reduced airway pressure and subcutaneous air. We recommend subcutaneous drains for safe, effective, and inexpensive management of massive subcutaneous emphysema.
A 47-year-old man developed subcutaneous emphysema of the right side of his face during a dental cleaning procedure by the dentist.
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Isolated subcutaneous emphysema appeared to cause significant pulmonary dysfunction in a traumatized child with no demonstrable intrinsic pulmonary injury or disease. We developed an animal model of severe thoracic subcutaneous emphysema to determine whether it alters pulmonary-thoracic compliance such that ventilation-perfusion relationships or cardiac performance are affected adversely. Twelve anesthetized, mechanically ventilated swine were studied. Baseline measurements and calculations included intrapulmonary shunt fraction (Qsp/Qt), total static pulmonary-thoracic compliance, thermodilution cardiac output, systemic and pulmonary arterial pressures, and mean pulmonary arterial occlusion pressure. Measurements and calculations were repeated after each of three consecutive injections of 400 cc of air into the tissue over the sternum. Comparison of the baseline values with those after the injections showed no increase in Qsp/Qt and no change in any other variable (p less than 0.05). We conclude that, in this model, isolated thoracic subcutaneous emphysema does not adversely affect cardiopulmonary function during positive pressure ventilation.
Epidural emphysema is a rare condition and usually accompanies pneumothorax, subcutaneous emphysema (SCE), or pneumomediastinum. We report a child who presented with epidural emphysema (pneumorachis) and SCE. The child was subsequently found to have a foreign body obstructing the airway, which was the likely cause of the pneumorachis. Thus, foreign body aspiration should be considered in an infant with SCE, and early intervention in the form of bronchoscopy should to be done to arrest the condition's progressive nature.
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We report a case of subcutaneous emphysema following multiple attempts to cannulate both subclavian veins for pacemaker insertion. Initial bilateral pneumothoraces were complicated by subcutaneous emphysema which became so severe that respiration and cardiac output became seriously impaired. The insertion of a single large bore subcutaneous drain produced a dramatic improvement. The aetiology, complications and management of tension subcutaneous emphysema are discussed.
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Subcutaneous emphysema is an unusual complication of nasal continuous positive airway pressure (CPAP). We report a case of a 58-year-old man who fell and sustained mild facial trauma to the left side of his head. After using CPAP the following night, he developed diffuse subcutaneous emphysema of his face and left neck. He discontinued CPAP, and his symptoms improved. The potential mechanisms of this patient's subcutaneous emphysema and the prior reports of this complication following facial trauma or dental procedure without use of CPAP are reviewed. Although there are case reports of bacterial meningitis and pneumocephalus following use of nasal CPAP, we are not aware of any prior reports of subcutaneous emphysema following use of CPAP. In light of our experience and the above related case reports, we would suggest nasal CPAP be withheld temporarily in the setting of acute facial trauma.
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