Subcutaneous Emphysema

A 22-year-old previously healthy man presented with acute sore throat awakening him from sleep (110). He had palpable crepitation due to extensive cervical subcutaneous emphysema. A chest X-ray showed a pneumomediastinum and bilateral apical pneumothoraces. CT scan did not show any underlying lung disease. Bronchoscopy was unremarkable except for a swollen nasal mucosa and acute bronchitis. Bronchoalveolar lavage was normal without evidence of infection. The patient reported repeated cocaine consumption. No tube drainage was necessary and the air collections resolved spontaneously within days. 

Pneumomediastinum caused by subcutaneous emphysema has been reported in a 30-year-old man after the application of hydrogen peroxide solution to a root canal. The patient had acute pulpitis of the lower right third molar, treated by extirpation followed by irrigation with 3% hydrogen peroxide solution. Soon after irrigation, subcutaneous emphysema developed (2). 

Of the procedures evaluated, 19 involved only minor complications, including fever over 38.1°C within 12 hours of pleurodesis in 13, asymptomatic hypoxemia in 19, dyspnea relieved by oxygen in six, and an increased need for narcotics in five. Subcutaneous emphysema, local infection, and asymptomatic hypotension each occurred after one procedure. There were major complications in 11 patients, including one patient with pulmonary embolism, three with unilateral pulmonary edema, eight who developed bilateral pulmonary edema, and one who died within 24 hours after bilateral talc administration. Patients developed respiratory complications after 24 of 28 talc pleurodesis procedures. The most significant respiratory complication was... 

Neck. Is there hoarseness, stridor, or subcutaneous emphysema ... 

Intense toxic inhalant exposures may cause pulmonary edema within 30 to 60 minutes. Secretions from both the nasopharynx and the tracheobronchial tree are copious, with quantities of up to 1 L/ h reported.12 Severe dyspnea is so prominent that the patient may refuse to move. On physical examination, the chest may be hyperinflated. Mediastinal emphysema secondary to peripheral air trapping may dissect to the skin and present as subcutaneous emphysema. The sudden death that occurs with massive toxic inhalant exposure is thought to be secondary to laryngeal spasm.13... 

Hypoxia improves as the bronchospasm improves, and long-term oxygen supplementation is rarely required. If long-term oxygen supplementation is needed, a search for other causes of hypoxia should be undertaken. Early institution of positive airway pressure (such as using a PEEP mask) may be useful. Positive pressure ventilation may be necessary if PEEP is insufficient to maintain Po2 greater than 60 mm Hg. Occasional reports of subcutaneous emphysema after chlorine exposure should not... 

Esophageal perforation can be diagnosed on frontal and lateral chest radiographs. Findings include pneumomediastinum, pneumothorax, hydro-pneumothorax, subcutaneous emphysema and pleural effusions (Fig. 2.30). Chest radiography is not useful... 

This presentation may be difficult to distinguish from antibiotic-resistant infectious pneumonia as sputum production, fever (25), and increased C-reactive protein (CRP) levels (24) are frequent. Pneumomediastinum and subcutaneous emphysema are occasional features (26,228,241). DAD is usually present at SLB (25,228,253,256), although NSIP is also described (25,234). Rapidly progressive ILD occurs more often in DM than in PM, at least in Asian populations, and is most frequent in patients with less prominent myositis (25,26,228,253,256). A novel antibody in CADM, anti-CADM-140 may be associated with rapidly progressive ILD (262). In 35.7% to 84.4% of cases, ILD is chronic, with insidious dyspnea and cough... 

Despite case reports of response to treatment with corticosteroids, larger studies have not shown any outcome benefit. Currently, accepted treatment options are limited to supportive care and prevention and treatment of infection. There is a report of three BMT recipients with IPS whose lung function improved following etanercept administration (13). Lung transplant may offer a therapeutic option for selected patients. Although the pneumonitis resolves in about 31%, the clinical course of IPS is often comphcated by viral and fungal infections, pneumothorax, pneumomediastinum, subcutaneous emphysema, pulmonary fibrosis, and autoimmune polyserositis (5). The case fatality of IPS is... 

Recognized complications of PN are pneumothorax, subcutaneous emphysema, arrythmias, massive hematoma during an attempt to place a central line in the subclavian vein, right atrial thrombosis, and embolism (82). Hepatic complications are seen in about 15% of patients depending on the duration and mode of application of PN (83), and metabolic bone disease may also occur (84,85). 

Although air-leak syndromes have not been recognized as a fatal complication in HSC transplant recipients, pneumothorax, pneumomediastinum and subcutaneous emphysema are potential complications of patients with chronic GVHD and BO. 

In these patients, air in the peribronchial sheets (pulmonary interstitial emphysema) can be associated with impairment of respiratory function and/or chest pain, possibly resulting from compression of small vessels by the interstitial air. In most patients, pulmonary interstitial emphysema is transient and it is well known that this process is difficult, if not impossible, to detect by chest radiograph. Chest CT should be performed in any HSC transplant recipient with known or suspected cGVHD who present with acute clinical symptoms, especially chest pain, to rule out associated air-leak syndromes. Therefore, suspicion of BO should be high and prompt therapy should be initiated in long-term HSC transplant recipients presenting with spontaneous pneumomediastinum, pneumothorax or subcutaneous emphysema (Franquet et al. 2007). 

Pulmonary conlusions Pulmonary lacerations Pneumothorax/haemo pneumothorax Traumatic lung cysts Interstitial emphysema Pneu momed iasti nu m Subcutaneous emphysema... 

There is a risk of pulmonary barotrauma. Manifestations include pneumothorax, air embolism, interstitial and subcutaneous emphysema, pneumomediastinum and pneumoperitoneum and retroperitoneum. It is clear, therefore, that IPPV or positive end-expiratory pressure (PEEP) ventilation should not be undertaken lightly in these patients in... 

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