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Clinical Images  |   October 2015
Extensive Case of Subcutaneous Emphysema
Author Notes
  • From the Department of Internal Medicine at Kent Hospital in Warwick, Rhode Island. 
  •  *Address correspondence to Desirae M. Budi, DO, 455 Toll Gate Rd, Warwick, RI 02886-2759. E-mail: dbudi@kentri.org
     
Article Information
Emergency Medicine / Imaging / Neuromusculoskeletal Disorders / Clinical Images
Clinical Images   |   October 2015
Extensive Case of Subcutaneous Emphysema
The Journal of the American Osteopathic Association, October 2015, Vol. 115, 633. doi:10.7556/jaoa.2015.131
The Journal of the American Osteopathic Association, October 2015, Vol. 115, 633. doi:10.7556/jaoa.2015.131
A 67-year-old man with no medical history presented to the emergency department with dyspnea and chest swelling, which developed after he fell on ice. His symptoms progressed in the emergency department to dysphonia and dysphagia with extensive facial swelling. A chest radiograph and computed tomographic scan showed subcutaneous emphysema, pneumomediastinum (image A), and hemopneumothorax with displaced rib fracture (image B). Subcutaneous emphysema manifests as painless tissue swelling secondary to air tracking along fascia into areas of least resistance.1 Chest and gastrointestinal trauma and infections can be sources of air leakage.2 Clinical signs include dysphagia, dyspnea, dysphonia, and crepitus. The patient’s crepitus extended from his cranial vertex to his knees, with popping sensations on palpation generated by air bubbles bursting under the pressure. Crepitus is often benign and self-limited until the patient’s breathing or blood supply becomes affected by the swelling, at which point surgically placed catheters are required.3 A chest tube was placed, preventing air from entering the subcutaneous space. On day 6, the chest tube was removed and the patient was discharged home on day 7. 
References
Frias Vilaça A, Reis AM, Vidal IM. The anatomical compartments and their connections as demonstrated by ectopic air. Insights into Imaging. 2013; 4(6): 759-772. doi:10.1007/s13244-013-0278-0. [CrossRef] [PubMed]
Eckstein M, Henderson SO. Thoracic trauma. In: Marx J, ed. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Saunders. 2013.
Bodenham A, Paramasivam E. Air leaks, pneumothorax, and chest drains. Contin Educ Anaesth Crit Care Pain. 2008; 8(6): 204-209. [CrossRef]