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Internal Medicine

Subcutaneous emphysema

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


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

Pathophysiology

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


Clinical features

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

Classification of severity:

12262_2013_975_fig1_html
Classification for severity of SE | Aghajanzadeh, M., Dehnadi, A., Ebrahimi, H., Fallah Karkan, M., Khajeh Jahromi, S., Amir Maafi, A., & Aghajanzadeh, G. (2015). Classification and Management of Subcutaneous Emphysema: a 10-Year Experience. The Indian Journal of Surgery, 77(Suppl 2), 673–677. https://doi.org/10.1007/s12262-013-0975-4

Diagnosis

Imaging

X-ray:

pulmonary_contusion
A chest X-ray of a right sided pulmonary contusion associated with flail chest and subcutaneous emphysema | Karim – http://www.trauma.org/index.php/main/image/32/, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=3988435

CT-scan:

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