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PubMed1994

Bilateral spontaneous pneumothoraces, pneumopericardium, pneumomediastinum, and subcutaneous emphysema: a rare presentation of paraquat intoxication.

Pneumothorax, subcutaneous emphysema, and pneumomediastinum occur frequently in critically ill patients in association with blunt or penetrating injuries or other conditions while performing Valsalva-like maneuvers. We present the case of a patient with bilateral pneumothoraces, pneumomediastinum, pneumopericardium, and subcutaneous emphysema after acute paraquat intoxication.

Acute Disease↗
PubMedDate not supplied

[Subcutaneous emphysema and pneumomediastinum after tonsillectomy and adenoidectomy].

In children, subcutaneous emphysema and pneumomediastinum are produced by bronchopulmonary infections, increased transalveolar pressure, bronchotracheal foreign bodies, and anesthetic or dental procedures. The case of a child with subcutaneous emphysema and pneumomediastinum after tonsillectomy and adenoidectomy is reported. The etiopathogenesis is discussed and the literature is reviewed.

Adenoidectomy↗
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↗
PubMed1996

Subcutaneous emphysema in a neonatal foal.

A 16-hour-old foal was examined because of subcutaneous emphysema, which began developing 3 hours after a routine delivery. Physical examination did not reveal soft-tissue or musculoskeletal trauma, and there were no skin injuries to explain the subcutaneous accumulation of air. Results of CBC and serum biochemical analysis were within reference limits, and findings on endoscopy of the pharyngeal area, trachea, and esophagus were within normal limits other than observation of dorsal pharyngeal compression. A pulmonary bulla, pneumomediastinum, and pneumothorax were detected on thoracic radiography. Because of the apparent association of the subcutaneous emphysema and thoracic abnormalities, a diagnosis of primary subcutaneous emphysema was made. A tracheostomy tube was placed to facilitate ventilation and to provide an exit point for the trapped air. Supportive care was provided. The foal's condition resolved over the subsequent 8 days.

Airway Obstruction↗
PubMed1995

Massive subcutaneous emphysema, pneumomediastinum, and spinal epidural emphysema as complications of violent coughing: a case report.

A 28-year-old man who manifested subcutaneous emphysema extending from the skull base and face to the chest, mediastinum and spinal epidural space following severe coughing caused by acute bronchitis is reported. Subcutaneous emphysema is a manifestation of non-surgical intrathoracic pathophysiology. In this patient percutaneous diagnostic peritoneal lavage resulted in the release of a large quantity of air and was negative for bleeding or contamination. No treatment other than antibiotics was prescribed. In this report, computer tomography study successfully demonstrated the areas of massive subcutaneous emphysema and the disappearance of the entrapped air, that might be absorbed into the tissues in the occupied sites within 7 days, except the air of epidural space, of a patient who manifested as a consequence of severe coughing caused by acute bronchitis.

Adult↗
PubMed1992

Subcutaneous emphysema from an axillary wound that resulted in pneumomediastinum and bilateral pneumothorax in a horse.

A 5-year-old Thoroughbred gelding was examined because of a small axillary wound sustained 5 days earlier and had resulted in extensive subcutaneous emphysema. Three days after admission, the horse's respiratory rate had increased to 72 breaths/min, and the horse appeared anxious and distressed. Thoracic radiography revealed pneumomediastinum and severe bilateral pneumothorax. Tube thoracostomy was performed on both hemithoraxes. The drains were connected to one-way suction valves and suction devices to decompress the thorax. A nasopharyngeal catheter was inserted, and oxygen insufflation was started. Cross ties were placed on the horse to limit movement, and the wound was packed. The horse improved within 30 minutes after initiating treatment. The horse was released 15 days after the development of pneumothorax, at which time the pneumothorax had resolved, the wound was no longer open, and the subcutaneous emphysema had greatly decreased. Although subcutaneous emphysema is usually regarded as a temporary cosmetic disfigurement, it can lead to serious complications such as pneumothorax. This case demonstrates that subcutaneous emphysema can lead to a life-threatening pneumothorax if the pressure is great enough to migrate through the mediastinum and into the pleural cavity. Horses with subcutaneous emphysema should be kept in confinement and monitored for the development of pneumothorax.

Animals↗
PubMed1981

Massive subcutaneous emphysema: an unusual presentation of jejunal perforation.

Massive diffuse subcutaneous emphysema resulting from perforation of the proximal jejunum is presented. Seventy-nine reported instances of subcutaneous emphysema of gastrointestinal origin were reviewed. Emphysema originating from the jejunum has not been previously reported. The colon (26 patients) and rectum (16 patients) were the more common sites of perforation. Perforations of the stomach and duodenum were found in 14 patients. The most common site for presentation of the subcutaneous air was the lower abdominal wall and thigh, and the more common causes were carcinoma of the colon and rectum and diverticulitis. The pathogenesis of emphysema in the patient described, as well as in the great majority of other patients, is from intraluminal gas rather than from gas-forming organisms. The air spreads along neurovascular bundles and other anatomic planes and may rapidly reach areas distant from the perforation. The recognition of these phenomena in the diagnosis of gastrointestinal perforation is important.

Clostridium Infections↗
PubMed1984

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.

Emphysema↗
PubMed1982

Subcutaneous emphysema.

Swelling appeared in an eight-year-old girl after amalgam restoration. The swelling, subcutaneous emphysema, due to the presence of air in the connective tissue disappeared over a period of two days; no complications occurred. The clinical importance of subcutaneous emphysema is that the migration of air to the mediastinum can cause death. According to the literature, many dental and oral procedures can cause subcutaneous emphysema. Since it can cause many complications due to infection, prophylactic antibiotic therapy is necessary.

Child↗
PubMed2006

Subcutaneous emphysema along cutaneous striae after laparoscopic surgery: a unique complication.

A case of postlaparoscopic subcutaneous emphysema developed along cutaneous striae was reported. A 35-year-old male patient with marked cutaneous striae underwent hand-assisted laparoscopic proctocolectomy for steroid-dependent ulcerative colitis. After an uneventful surgery, he developed subcutaneous emphysema, which was noted along the cutaneous striae in the bilateral thigh. The localization of emphysema suggested that Pfannensteil mini-laparotomy for hand access was most responsible for the development of subcutaneous emphysema.

Adult↗
PubMed1984

[Subcutaneous emphysema, pneumomediastinum and dental extraction].

One case of pneumomediastinum due to subcutaneous emphysema occurring after using a high speed air turbine drill during dental extraction was described, as only a few cases have been published in the literature. Air may have entered the soft tissues directly by being forced down the gingival crevice. The air may then have passed by way of the fascial planes to enter deeper structures and the mediastinum. The consequences of this condition after general anaesthesia were discussed, more common aetiologies being tracheal or oesophageal rupture, bronchial rupture or pneumothorax.

Adult↗
PubMed1993

Acute ventilatory failure from massive subcutaneous emphysema.

A 66-year-old woman developed massive subcutaneous emphysema following intubation. Acute thoracic restriction developed resulting in life-threatening respiratory acidosis. The patient could not be ventilated with conventional means. A tracheostomy was performed to decompress the chest and mediastinum with rapid resolution following. Although ventilatory failure from subcutaneous emphysema is very unusual, decompression with tracheostomy can be life saving.

Acute Disease↗
PubMed2005

Unilateral subcutaneous emphysema after percutaneous tracheostomy.

PURPOSE: Percutaneous tracheostomy techniques are widely used in intensive care units. Subcutaneous emphysema is a rare but well recognized complication associated with this procedure. We report an unusual presentation of sc emphysema after percutaneous tracheostomy. The clinical features, diagnosis and postulated mechanism are discussed. CLINICAL FEATURES: A 39-yr-old man had percutaneous tracheostomy done after prolonged intubation in the intensive care unit. Subcutaneous emphysema developed over the right neck fever mimicking deep sc infection resulted in neck exploration. No obvious lesion was found in the tracheobronchial tree. CONCLUSION: Subcutaneous emphysema occurring after percutaneous tracheostomy could occur without significant injury to the tracheobronchial tree. We postulate that air leaking from the tracheostomy site might have been prevented by the snug fit between the tracheostomy tube and the skin, resulting in accumulation in the neck. Asymmetric dilatation of the trachea may explain the unilateral localization of the sc emphysema.

Adult↗
PubMed2000

Subcutaneous emphysema following trans-cricothyroid membrane injection of local anesthetic.

PURPOSE: To present a case of preoperative subcutaneous emphysema (SCE) as a complication of trans-cricothyroid membrane (TCM) injection of lidocaine for awake intubation. CLINICAL FEATURES: A 48-yr-old man with cervical myelopathy was scheduled for elective cervical discectomy. Airway topical anesthesia consisted of lidocaine pledgets and TCM injection. After successful awake fibreoptic intubation was performed, SCE was noted in the neck region. The main differential diagnosis of preoperative SCE included air leak via the anterior needle track from TCM injection or disruption of mucosal membrane in the aerodigestive tract. The latter was excluded by panendoscopy and an upper GI swallow study. The most likely explanation for SCE was air leak from the anterior needle tract. The subcutaneous emphysema resolved spontaneously without sequella. CONCLUSION: Subcutaneous emphysema is a rare but potentially serious complication of TCM injection of lidocaine. Anesthesiologists should be familiar with the differential diagnosis, investigations and management of SCE.

Anesthetics, Local↗
PubMed1995

Extensive subcutaneous emphysema and hypercapnia during laparoscopic cholecystectomy: two case reports.

We report two cases of marked hypercapnia of more than 60 mm Hg (PaCO2) and extensive subcutaneous emphysema noted during laparoscopic cholecystectomy. The first case, a 55-year-old man was diagnosed as having cholecystolithiasis and had hypercapnia up to 83.5 mm Hg (PaCO2) during laparoscopic cholecystectomy. The patient resumed spontaneous respiration under controlled ventilation accompanied by persistent bigeminal pulse. Soon after deflation, CO2 returned to normal range, and extensive subcutaneous emphysema was detected in the recovery room. The second patient, a 53-year-old woman, had cholecystolithiasis and also underwent laparoscopic cholecystectomy. Both hypercapnia rising to 61.1 mm Hg (PaCO2) and extensive subcutaneous emphysema appeared just before completion of resection of the gallbladder. Mild hypercapnia during pneumoperitoneum of about 50 mm Hg (PaCO2) has been reported previously. As compared with cases in the literature, the present cases suggest that hypercapnia is due to extensive subcutaneous emphysema. The large absorption surface area in the subcutaneous tissue and the large difference in the partial pressure cause the extensive gaseous interchange of CO2 between subcutaneous tissue and blood perfusing into it at the moment between peritoneal cavity and blood perfused the peritoneum.

Carbon Dioxide↗
PubMed1997

Subcutaneous emphysema as an uncommon presentation of child abuse.

A case of subcutaneous emphysema and pneumomediastinum as a result of child abuse is presented to add to the spectrum of findings associated with child maltreatment. This case is a reminder that although most cases of subcutaneous emphysema resolve uneventfully, there still needs to be an aggressive search for a cause. In addition, in the pediatric age group, the history given should be carefully verified as being plausible because of the possibility that child abuse may be the true etiology.

Child Abuse↗