Subcutaneous/surgical emphysema (SCE, SE) is when gas or air is in the layer under the skin.

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Aetiology

Trauma:

• Fractures of the facial bones with sinus involvement
• Neck surgery
• Penetrating gunshot injuries of head & neck or chest
• Penetrating trauma to gastrointestinal/respiratory systems

Iatrogenic:

• Anesthesia either during endotracheal/naso-tracheal intubation
• Laparoscopy—tearing of the tracheal mucosa during intubation, increased pressure in the alveoli because of excessive ventilation pressure, improper chest tube placement during chest surgery, dental high speed hand pieces)

Incidental:

• Barotrauma (diving, positive pressure ventilation)
• Labour
• Foreign body

Pathological causes:

• Anaerobic, clostridia, mixed, gas-forming facultative aerobic infections

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Pathophysiology

Rupture of broncho-alveolar walls with escape of air into the subcutaneous plane.

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Clinical features

• Swelling around neck + chest pain (M/C & visible sign)

Classification of severity:

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Diagnosis

Imaging

X-ray:

CT-scan: