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PubMed1984

Massive subcutaneous emphysema following colonoscopy.

A case of massive subcutaneous emphysema following colonoscopic polypectomy is reported. The incidence of colonic perforation following colonoscopy is 0.1% and may be intraperitoneal or retroperitoneal. Intraperitoneal perforation is usually immediately apparent and likely to require urgent surgical exploration. The development of subcutaneous emphysema or a pneumoscrotum suggests a retroperitoneal perforation and in the majority of cases management is conservative. Contrast studies are often unhelpful but plain x-rays may help to distinguish between intraperitoneal and retroperitoneal perforations.

Aged↗
PubMed1996

[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↗
PubMed1996

[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↗
PubMedDate not supplied

Pneumomediastinum, subcutaneous emphysema, and pulmonary fibrosis in a patient with idiopathic pneumonia syndrome after bone marrow transplantation.

An adolescent female underwent bone marrow transplantation for relapsed leukemia and developed acute and chronic graft-versus-host disease and idiopathic pneumonia syndrome. Her lung disease responded to large doses of methylprednisolone but evolved to pulmonary fibrosis and pneumomediastinum and subcutaneous emphysema in the convalescent period. Pulmonary function tests revealed a restrictive pattern. Pneumomediastinum and subcutaneous emphysema are complications not only of obstructive but also of restrictive lung disease and vary with respect to time of onset.

Acute Disease↗
PubMed1997

Retroperitoneal perforation in ulcerative colitis with mediastinal and subcutaneous emphysema.

Retroperitoneal colonic perforation in patients with ulcerative colitis is rare. We report such a case in a patient with severe ulcerative colitis without toxic dilatation in whom mediastinal and subcutaneous emphysema also developed. Unlike previously reported cases, our patient was treated conservatively with intravenous fluids, parenteral nutrition, intravenous hydrocortisone, and antibiotics. After 2 weeks, the mediastinal and subcutaneous emphysema and the retroperitoneal air completely disappeared.

Adult↗
PubMed2004

Surgical emphysema: a rare presentation of foreign body inhalation.

An 11-year-old girl with an almond lodging in the tracheobronchial tree is described. She presented with an uncommon symptom of subcutaneous emphysema The x-ray revealed left-sided pneumothorax and pneumomediastinum. Intercostal drain was inserted, but she developed respiratory failure and was ventilated. After initial stabilization for 60 hours, she deteriorated again and her x-ray revealed right-sided collapse. After removal of the foreign body, she was discharged but presented again with stridor necessitating tracheostomy. Tracheal stenosis was found and required end-to-end anastomosis. The authors feel that, while foreign bodies are uncommon in this age group with emphysema as a rarer manifestation, this cause should be kept in mind, even in the absence of forthcoming history. A high index of suspicion for tracheobronchial foreign body is required in atypical presentations of acute pediatric respiratory distress.

Airway Obstruction↗
PubMed1997

Pneumomediastinum and subcutaneous emphysema associated with fatal interstitial pneumonia in dermatomyositis.

We described a 65-year-old woman who died of acute interstitial pneumonia associated with dermatomyositis. Subcutaneous emphysema and pneumomediastinum simultaneously developed. The association of the pulmonary rupture with vasculitis has been assumed as the common cause in interstitial pneumonia. Diffuse alveolar damage, however, might have led to the pneumomediastinum and subcutaneous emphysema in our patient, who had no signs of cutaneous vasculitis.

Aged↗
PubMed1982

Status asthmaticus. Management of status asthmaticus complicated by surgical emphysema--avoidance of intermittent positive pressure ventilation.

The management of a case of status asthmaticus complicated by surgical emphysema is described. In view of voice changes, intubation was necessary but intermittent positive pressure ventilation was considered unwise, because of the surgical emphysema. A means of maintaining adequate sedation in an intubated patient whilst allowing spontaneous respiration is outlined.

Adult↗
PubMed1993

Subcutaneous emphysema, pneumomediastinum and pneumothorax complicating laparoscopic vagotomy. Report of two cases.

Two patients developed subcutaneous emphysema and pneumomediastinum during laparoscopic vagotomy. One of the patients also had a pneumothorax which produced a sudden increase in end-tidal carbon dioxide concentration preceding arterial oxygen desaturation. The pneumothorax was drained with an intercostal cannula. The patient required a twofold increase in minute ventilation to maintain normocarbia, probably because of the additional absorption of carbon dioxide through the pleural cavity. Despite the presence of a peritoneo-pleural communication, surgery was successfully completed. We believe that gas under tension in the peritoneal cavity dissected along tissue planes around the oesophagus opened up during surgery. Thus pneumomediastinum, subcutaneous emphysema and pneumothorax are definite risks associated with this new procedure.

Adult↗
PubMed1984

Subcutaneous emphysema: a new form of self abuse.

Subcutaneous emphysema is usually the result of trauma or surgery. We report an unusual case of a disturbed adolescent who presented with cervicofacial emphysema as a result of self abuse.

Adolescent↗
PubMed2006

Spontaneous pneumopericardium, pneumomediastinum and subcutaneous emphysema: unusual complications of asthma in a 2-year-old boy.

A 2-year-old boy presented to the emergency department with a history of sudden onset of cough, dyspnoea and a slight expiratory wheeze on the right lung base. He also had subcutaneous emphysema on the left side of the chest anteriorly. Chest x ray confirmed subcutaneous emphysema and also revealed pneumomediastinum and pneumopericardium. He had had no previous episode and was not known to have asthma. He was apyrexial but had a raised white cell count. The eosinophil count was within normal limits. He was successfully treated with nebulised salbutamol, steroids, antibiotics and high flow oxygen. He made a good recovery and was discharged after 7 days. This case highlights the need for a high index of suspicion of asthma in very young children presenting for the first time with such complications.

Albuterol↗
PubMed1961

An assessment of the anatomical factor in cor pulmonale in emphysema.

The morbid anatomical factors in the production of right heart hypertrophy and failure in emphysema have been reviewed with reference to 44 cases studied by standard histological methods and by post-mortem pulmonary arteriography. The most important factors in raising the pulmonary vascular resistance in these cases are considered to be vascular deformity and pressure by the emphysematous spaces on the adjacent branches of the pulmonary artery. Precapillary bronchopulmonary arterial anastomoses may be of importance in those cases where areas of localized bronchiectasis are present. Intimal fibrosis of the pulmonary arterioles, destruction of the pulmonary vascular bed, and thromboembolic phenomena were thought to be of only minor importance in the production of cor pulmonale in emphysema.

Autopsy↗
PubMed1993

Subcutaneous emphysema and pneumomediastinum following dental extraction.

A case of acute subcutaneous emphysema of the lateral region of the neck is described. The patient, a 26-year-old woman, also had radiologic evidence of pneumomediastinum. She completely recovered in a few days under prophylactic antibiotherapy. In this case, subcutaneous and mediastinal emphysema was most probably due to the introduction of air into the soft tissue during dental surgery using compressed air equipment.

Adult↗
PubMed2006

Spontaneous cervical emphysema and pneumomediastinum in an 18-year-old woman.

Pneumomediastinum or mediastinal emphysema is a known complication of traumatic injury or disease whereas spontaneous pneumomediastinum remains a rare clinical entity. We present the case of a young woman with a diagnosis of spontaneous pneumomediastinum combined with cervical emphysema without any precipitating factors or disease.

Adolescent↗
PubMed1992

Subcutaneous emphysema, pneumomediastinum, and potentially life-threatening tension pneumothorax. Pulmonary complications from arthroscopic shoulder decompression.

Subcutaneous emphysema, pneumomediastinum, and tension pneumothorax are previously unreported complications of shoulder arthroscopy with subacromial decompression. Three patients developed extensive subcutaneous emphysema, pneumomediastinum, and bilateral tension pneumothorax during or immediately after shoulder arthroscopy with subacromial decompression. The procedure was terminated and appropriate treatment was given. All three patients recovered completely with no residual damage. The complications are thought to be associated with the extravasation of air that may be drawn in from the lateral portal when the arthroscopic infusion pump and power shaver with suction are turned on. Early diagnosis, followed by immediate termination of the infusion pump and suction shaver along with appropriate treatment can be life-saving.

Adult↗
PubMed1998

Rapidly progressive extensive subcutaneous emphysema associated with an implantable intratracheal oxygen catheter.

Localized subcutaneous emphysema is a recognized complication of transtracheal oxygen catheters. It usually occurs in the immediate postoperative period or in association with catheter tip migration. This is a case of rapidly progressive, extensive subcutaneous emphysema apparently resulting from paroxysms of coughing in a patient with a normally functioning implanted intratracheal oxygen catheter several weeks after placement.

Aged↗
PubMed2001

Cervical emphysema, pneumomediastinum, and pneumothorax following self-induced oral injury: report of four cases and review of the literature.

Spontaneous rupture of the pulmonary alveoli after a sudden increase in intra-alveolar pressure is a common cause of pneumomediastinum, which is usually seen in healthy young men. Other common causes are traumatic and iatrogenic rupture of the airway and esophagus; however, pneumomediastinum following cervicofacial emphysema is much rarer and is occasionally found after dental surgical procedures, head and neck surgery, or accidental trauma. We present four cases of subcutaneous emphysema and pneumomediastinum with two secondary pneumothoraces after self-induced punctures in the oral cavity. They constitute an uncommon clinical entity that, to our knowledge, has not been reported in the literature. Its radiologic appearance, clinical presentation, and diagnosis are described.

Adult↗