1
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Bishop L, MacLaren S, Pollitt W. Delayed traumatic subcutaneous emphysema: a case report. J Med Case Rep 2025; 19:258. [PMID: 40448153 DOI: 10.1186/s13256-025-05249-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2024] [Accepted: 04/04/2025] [Indexed: 06/02/2025] Open
Abstract
BACKGROUND Subcutaneous emphysema is a common, usually benign, and self-limiting complication of traumatic chest wall injury. In a minority of thoracic injuries, pneumothoraces can result in extensive subcutaneous emphysema and subsequent airway obstruction if air tracks along tissue planes within the neck. Furthermore, patients may have a delay to presentation following chest-wall injury and can rapidly decline. Hence, we discuss a case of delayed traumatic subcutaneous emphysema resulting in airway compromise, without cardiorespiratory compromise from tension pneumothoraces. CASE PRESENTATION A white British female in her 70s attended the emergency department 24 h after a fall at home with the complaint of right sided chest pain and shortness of breath. On arrival, the patient appeared well, with no sign of compromise. The patient rapidly deteriorated over the course of the next 30 min. Massive crepitus swelling was identified of her upper and lower limbs, head (including palpebral closure), neck, chest, and abdomen. Vocal changes and early airway obstruction features were identified. Prompt recognition of rapidly progressive subcutaneous emphysema with airway compromise, early rapid-sequence induction, chest-drain insertion, and a multidisciplinary team approach ensured a positive outcome, with discharge home after 12 days in hospital. CONCLUSION Subcutaneous emphysema itself is rarely life-threatening, though it can infrequently manifest as an obstructive airway emergency. Delayed presentations are possible, and the presence of subcutaneous emphysema indicates severe chest-wall injury. Airway protection and treatment of pneumothoraces are critical interventions for these patients.
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Affiliation(s)
- Lucas Bishop
- University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Sarah MacLaren
- Royal Devon and Exeter Hospital Emergency Department, Barrack Road, Exeter, EX2 5DW, UK
| | - William Pollitt
- Royal Devon and Exeter Hospital Emergency Department, Barrack Road, Exeter, EX2 5DW, UK
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2
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Lobdell KW, Perrault LP, Drgastin RH, Brunelli A, Cerfolio RJ, Engelman DT. Drainology: Leveraging research in chest-drain management to enhance recovery after cardiothoracic surgery. JTCVS Tech 2024; 25:226-240. [PMID: 38899104 PMCID: PMC11184673 DOI: 10.1016/j.xjtc.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/18/2024] [Accepted: 04/01/2024] [Indexed: 06/21/2024] Open
Affiliation(s)
- Kevin W. Lobdell
- Sanger Heart & Vascular Institute, Wake Forest University School of Medicine, Advocate Health, Charlotte, NC
| | - Louis P. Perrault
- Montréal Heart Institute, Université de Montréal, Montréal, Quebec, Canada
| | | | - Alessandro Brunelli
- Department of Thoracic Surgery, Leeds Teaching Hospitals, Leeds, United Kingdom
| | | | - Daniel T. Engelman
- Heart & Vascular Program, Baystate Health, University of Massachusetts Chan Medical, School-Baystate, Springfield, Mass
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3
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Sarbay I, Turna A. A case report of subconjunctival emphysema as a rare complication of pulmonary resections. J Minim Access Surg 2024; 20:105-107. [PMID: 37282426 PMCID: PMC10898631 DOI: 10.4103/jmas.jmas_248_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/08/2022] [Accepted: 12/09/2022] [Indexed: 03/19/2023] Open
Abstract
Lung volume reduction surgery (LVRS) is performed to the selected patients with lung emphysema who have higher residual volume, restricted pulmonary functions and limited diaphragmatic movement. Post-operative prolonged air leak is not uncommon following LVRS due to pulmonary emphysema. In some patients with prolonged air leak, pneumoderma may develop. Subconjunctival emphysema is a bizarre and very rarely seen complication. We report a patient suffering from subconjunctival emphysema after an LVRS along with a diagnostic wedge resection for a suspected pulmonary nodule which was revealed to be a large cell neuroendocrine carcinoma. The condition was resolved with conservative management with no visual impairment. He has been doing well and tumour free for 38 months.
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Affiliation(s)
- Ismail Sarbay
- Department of Thoracic Surgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Akif Turna
- Department of Thoracic Surgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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4
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Siddiqui S, Falak U, Frost N, Athar W, Memon MHM, Qazi AZ. Can sub-cutaneous drain safely counter debilitating surgical emphysema? A retrospective study in quest for an answer. Respirol Case Rep 2024; 12:e01285. [PMID: 38269314 PMCID: PMC10807986 DOI: 10.1002/rcr2.1285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/27/2023] [Indexed: 01/26/2024] Open
Abstract
Literature evidence on sub-cutaneous drain insertion in severe surgical emphysema (SE) is lacking. We retrospectively reviewed the clinical notes of 5 patients who underwent insertion of sub-cutaneous drains to manage SE of various aetiologies between September 2022 to August 2023 in a single district general hospital in the UK. Case history, outcome following sub-cutaneous drain insertion, and side effects due to the procedure were collected. Clinical decompression were noticed within an hour of drain insertion in all patients. Radiological resolution ranged between 2 and 10 days with a median 3 days and mean of 4.8 days. Patients with uni-lateral sub-cutaneous drain required more time for radiological improvement than patients on bi-lateral drains (median 6.5 vs. 2, mean 6.5 vs. 3.6). Maximum duration for resolution was 10 days for patients receiving uni-lateral sub-cutaneous drain versus 7 days in patients having bi-lateral drains. Only one patient had no prior lung disease making it difficult to comment if having healthy lungs affects outcomes. Sub-cutaneous drain insertion is a safe procedure which can accelerate recovery in severe SE.
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Affiliation(s)
- Saquib Siddiqui
- Respiratory MedicineRoyal Victoria Infirmary HospitalNewcastle Upon TyneUK
| | - Umair Falak
- Respiratory MedicineQueen Elizabeth HospitalGatesheadUK
| | - Ned Frost
- Respiratory MedicineQueen Elizabeth HospitalGatesheadUK
| | - Waseem Athar
- Respiratory MedicineQueen Elizabeth HospitalGatesheadUK
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5
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Poirier M, Walton RAL. The successful use of a subcutaneous catheter in the management of severe subcutaneous emphysema in a dog with laryngeal crush injury and tracheostomy tube placement. J Vet Emerg Crit Care (San Antonio) 2023; 33:710-714. [PMID: 37793056 DOI: 10.1111/vec.13322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 06/26/2022] [Accepted: 06/30/2022] [Indexed: 10/06/2023]
Abstract
OBJECTIVE To describe the placement of a subcutaneous catheter in a dog for the management of severe subcutaneous emphysema secondary to severe laryngeal crushing injury and temporary tracheostomy tube placement. CASE SUMMARY A 6-year-old male neutered Kelpie suffered a severe laryngeal crushing injury following a dog attack. Case management included the placement of a temporary tracheostomy tube due to severe respiratory compromise and inspiratory dyspnea associated with the crush injury. During hospitalization, the patient developed severe subcutaneous emphysema, pneumomediastinum, and a pneumothorax as a complication of the laryngeal crushing injury and temporary tracheostomy. A subcutaneous catheter was placed to manage the recurrent subcutaneous emphysema while the tracheostomy stoma healed. Five months posttrauma, the dog returned to normal with mild stridor during excitement and while panting. NEW OR UNIQUE INFORMATION PROVIDED This is the first report in veterinary medicine describing the use of a subcutaneous catheter for the management of subcutaneous emphysema secondary to laryngeal crush injury and temporary tracheostomy tube placement.
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Affiliation(s)
- Maude Poirier
- Department of Small Animal Emergency and Critical Care, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Rebecca A L Walton
- Department of Small Animal Emergency and Critical Care, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
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6
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Carleton L, Eilbert W, Grant R. Extensive subcutaneous emphysema treated with subcutaneous angiocatheters. J Am Coll Emerg Physicians Open 2023; 4:e13054. [PMID: 37840863 PMCID: PMC10568045 DOI: 10.1002/emp2.13054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/24/2023] [Accepted: 09/27/2023] [Indexed: 10/17/2023] Open
Abstract
Subcutaneous emphysema (SCE) seen in the emergency department is usually the result of traumatic chest injuries, surgical complications, or invasive airway procedures. SCE is usually a self-limiting phenomenon involving the chest wall and neck, though may progress to involve the deeper tissues leading to respiratory and cardiovascular compromise. Emergent intervention is indicated in such cases of extensive SCE, though the ideal approach to its management is not known. We report a case of successful decompression of extensive SCE using subcutaneous placement of angiocatheters.
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Affiliation(s)
- Lena Carleton
- Department of Emergency MedicineCollege of MedicineUniversity of IllinoisChicagoUSA
| | - Wesley Eilbert
- Department of Emergency MedicineCollege of MedicineUniversity of IllinoisChicagoUSA
| | - Randall Grant
- Department of Emergency MedicineCollege of MedicineUniversity of IllinoisChicagoUSA
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7
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Goyal M, Jimmy JK, Dixit R, Garg DK. A study of subcutaneous emphysema, factors contributing to its development, resolution and management with different modalities. Monaldi Arch Chest Dis 2023; 94. [PMID: 37367102 DOI: 10.4081/monaldi.2023.2583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023] Open
Abstract
Subcutaneous emphysema (SE) is defined as an escape of air in subcutaneous tissue. It is one of the most common complications after intercostal chest tube drainage. SE is usually benign, requiring no specific treatment, but extensive SE can be uncomfortable and alarming for the patient. It can rarely lead to airway compromise, respiratory failure, and death. Factors leading to its development, following chest tube insertion and methods of management, have not been extensively studied and published. This was an analytical study done over 2 years on indoor patients who developed SE. These cases were managed using four different modalities and were analyzed for various factors contributing to the development, severity, and resolution of SE. The results of this study highlight that the cases of hydropneumothorax and secondary pneumothorax were significantly more predisposed to the development of severe SE (following intercostal chest tube insertion) and large air leaks as compared to others. A larger air leak develops higher grades of SE. The average time for resolution of SE was similar among the different modalities of management compared in the study.
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Affiliation(s)
- Mukesh Goyal
- Department of Respiratory Medicine, Jawaharlal Nehru Medical College, Ajmer.
| | - Jose K Jimmy
- Department of Critical Care Medicine, Mar Sleeva Medicity Palai, Cherpunkal.
| | - Ramakant Dixit
- Department of Respiratory Medicine, Jawaharlal Nehru Medical College, Ajmer.
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8
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Muacevic A, Adler JR, Pursel J, Henry G. Extensive Subcutaneous Emphysema Associated With Pneumothorax, Pneumomediastinum, and Pneumoperitoneum: A Case Report. Cureus 2022; 14:e31816. [PMID: 36579188 PMCID: PMC9783338 DOI: 10.7759/cureus.31816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 11/24/2022] Open
Abstract
Subcutaneous emphysema (SE ) is a phenomenon in which air occupies structures under the skin and soft tissues. Common sites for SE include the neck and chest wall, which can extend to other body regions. In this case report, we describe the development of extensive SE, pneumothorax, pneumomediastinum, and pneumoperitoneum in an elderly female following blunt trauma to her right flank. The etiology of SE is broad and includes blunt and penetrating traumas; surgical, infectious, spontaneous causes; or any condition that yields a gradient between intra-alveolar and perivascular interstitial pressures. The incidence of SE has been reported to be 1.4%, while that of spontaneous pneumothorax has been reported to be 0.8% in patients receiving a percutaneous tracheostomy. Conversely, the occurrence of SE, pneumothorax, pneumomediastinum, and pneumoperitoneum in the same patient is rare. The most common signs and symptoms of SE are neck swelling and chest pain. Involvement of the deeper tissues of the thoracic outlet, chest, and abdominal wall often manifests in severe life-threatening conditions. SE can be diagnosed by detecting edema and crepitus of the scalp, neck, thorax, abdomen, and other body regions. Radiograph imaging can confirm the presence of soft-tissue air entry. Extensive SE in the setting of pneumothorax is an unusual entity for which there is, as of now, no consensus in management. Methods of treatment include supportive care, placement of blow holes for evacuation of soft-tissue emphysema, and bilateral infraclavicular incisions. SE is a rare complication that can arise from several etiologies. At the same time, various methods for managing this phenomenon have been mentioned with varying successful outcomes.
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9
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Kramer LM, Walton KL. Survey of current trends in the management of traumatic subcutaneous emphysema in dogs. J Vet Emerg Crit Care (San Antonio) 2022; 32:549-554. [PMID: 35001489 DOI: 10.1111/vec.13172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 07/20/2020] [Accepted: 08/06/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Subcutaneous emphysema (SCE) is a common occurrence in emergency veterinary practice, but published information regarding treatment and management strategies is lacking. This study examined trends in diagnostic and treatment recommendations. STUDY DESIGN An internet-based survey with cross-sectional analysis. There were 129 respondents: board-certified and nonboard-certified veterinarians in private practice and university settings. KEY FINDINGS Significant differences in the choice of diagnostics and treatment were found based on the etiology and severity of SCE and between respondent groups. Computed tomography (CT) was selected more frequently for SCE resulting from blunt or penetrating traumas by the board-certified veterinarians practicing in a teaching hospital (VTH group; P < 0.001). All veterinarians were more likely to select tracheobronchoscopy as part of their workup for SCE as a result of endotracheal intubation trauma (P = 0.0093 [penetrating traumas]; P = 0.0002 [blunt force traumas]). Intermittent SC drainage and ventral cervical exploratory surgery were more likely to be chosen as treatments when SCE was classified as severe generalized (P < 0.0001). SIGNIFICANCE There is significant variation in the treatment of SCE in veterinary medicine as well as associated diagnostics to determine severity and treatment options. Further studies are indicated to determine the optimal approach and provide guidance to clinicians.
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Affiliation(s)
- Leah M Kramer
- Cape Cod Veterinary Specialists, Buzzards Bay, Massachusetts, USA
| | - Karie L Walton
- Cape Cod Veterinary Specialists, Buzzards Bay, Massachusetts, USA
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10
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Soler-Silva Á, Sánchez-Guillén L, Rodriguez-Arias FL, Arroyo A. Negative pressure therapy as a safe alternative in the treatment of massive subcutaneous emphysema in critically ill patients COVID-19. Heart Lung 2022; 52:190-193. [PMID: 35063307 PMCID: PMC8755478 DOI: 10.1016/j.hrtlng.2022.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/03/2022] [Accepted: 01/10/2022] [Indexed: 01/25/2023]
Abstract
Many surgical treatments have been described for massive subcutaneous emphysema (MSE) over the recent years. However, there is no consensus on which is the most recommended and there is great diversity in treatment. With new advances in minimally invasive therapy performed at the bedside, especially in intensive care units, it has been possible to increase therapeutic efficacy. During the COVID-19 pandemic, some therapeutic techniques have been discussed in critically ill patients with SARS-COV-2 respiratory infections, because of the potential overexposure of healthcare personnel to an increased risk of contagion after direct exposure to air trapped in the subcutaneous tissue of infected patients. We present the clinical case of an 82-year-old male patient, SARS COV-2 infected, with MSE after 48 h with invasive mechanical ventilation in critical intensive care. He was treated with negative pressure therapy (NPT) allowing effective resolution of the MSE in a short period (5 days) with a minimally invasive bedside approach, reducing the potential air exposure of health personnel by keeping the viral load retained by the emphysema. Therefore, we present NPT as an effective, minimally invasive and safe therapeutic alternative to be considered in the management of MSE in critically ill patients infected with SARS COV-2.
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Affiliation(s)
- Álvaro Soler-Silva
- Department of General Surgery, Colorectal Unit, Elche University Hospital, Alicante, Spain,Department of Pathology and Surgery of University Miguel Hernández of Elche, Alicante, Spain
| | - Luis Sánchez-Guillén
- Department of General Surgery, Colorectal Unit, Elche University Hospital, Alicante, Spain,Department of Pathology and Surgery of University Miguel Hernández of Elche, Alicante, Spain,Corresponding author at: Camino de la Almazara 11, Hospital General Universitario de Elche, 03203 Elche. Alicante, Spain
| | - Francisco López Rodriguez-Arias
- Department of General Surgery, Colorectal Unit, Elche University Hospital, Alicante, Spain,Department of Pathology and Surgery of University Miguel Hernández of Elche, Alicante, Spain
| | - Antonio Arroyo
- Department of General Surgery, Colorectal Unit, Elche University Hospital, Alicante, Spain,Department of Pathology and Surgery of University Miguel Hernández of Elche, Alicante, Spain
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11
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Nyi T, Chrastek D, Shah S, Kouritas V. Tracheal laceration causing important post-intubation delayed subcutaneous emphysema and ventilatory deterioration in a COVID-19 patient with severe rheumatoid arthritis: a case report. MEDIASTINUM (HONG KONG, CHINA) 2021; 5:30. [PMID: 35118335 PMCID: PMC8799927 DOI: 10.21037/med-21-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/04/2021] [Indexed: 06/14/2023]
Abstract
A 68-year-old man with a background of severe active rheumatoid arthritis (RA) was admitted to Intensive Care Unit (ICU) for respiratory support due to COVID-19 infection. Two days after an elective and uneventful intubation he developed severe and worsening surgical emphysema affecting his face, neck and both upper limbs. Ventilation was difficult to be achieved. Based on a negative chest X-ray, a CT scan of the chest was organized which showed extensive pneumomediastinum with no obvious cause. Therefore, urgent bronchoscopy was performed which showed a glassy lesion/laceration measuring 2 cm × 2 cm at the level of mid-trachea but no other signs of penetration through the airways were noted. Since events appeared 2 days after intubation, this was perceived as secondary to trauma during intubation on an inflammatory process background from RA and COVID-19 in the airways. The endotracheal tube was progressed beyond the site of laceration and bilateral pectoral fasciotomies were performed with negative suction vacuum dressings, which was successful in decreasing the surgical emphysema and achieving decreased ventilation requirements. Despite multi-organ support the patient continued to deteriorate and unfortunately passed away a week following admission. This scenario hightlighted that endotracheal sequalae should be suspected in patients with similar background and presentation.
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Affiliation(s)
- Tha Nyi
- Department of Anesthesia and Intensive Care, Norfolk and Norwich University Hospital, Norwich, UK
| | - David Chrastek
- Department of Thoracic Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - Shalesh Shah
- Department of Anesthesia and Intensive Care, Norfolk and Norwich University Hospital, Norwich, UK
| | - Vasileios Kouritas
- Department of Thoracic Surgery, Norfolk and Norwich University Hospital, Norwich, UK
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12
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Patel MIA, Barabas A. "Fish Gill" Incisions for Severe Periorbital Surgical Emphysema Following Tension Pneumothorax - A Case Report and Review of the Literature. JPRAS Open 2021; 30:128-132. [PMID: 34557580 PMCID: PMC8445807 DOI: 10.1016/j.jpra.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/04/2021] [Indexed: 12/02/2022] Open
Abstract
Background Surgical emphysema refers to the presence of air within the subcutaneous space and is a known complication of chest drain insertion. Symptoms range from mild crepitus of the chest wall to the accumulation of air in the face and neck, which can ultimately result in cardiovascular compromise. Objective The aim of this article is to present a rare case of cervical, facial and periorbital surgical emphysema following chest drain insertion, and describes a novel use of ‘fish gill’ incisions in the palpebromalar groove with an associated review of the literature. Case Report A 68-year-old gentleman presented with acute dyspnoea due to a right-sided tension pneumothorax. Emergency decompression with a Seldinger chest drain resulted in persistent cervical, facial and periorbital surgical emphysema causing difficulty in movement, inability to open the eyes and progressive risk to cervical venous return. “Fish gill’ incisions at the lateral-most edge of the palpebromalar groove, down to the level of the orbicularis oculi muscle, rapidly released air from the face and neck, alleviating discomfort, reducing venous compression and restoring vision. Conclusion Cervical, fascial and periorbital surgical emphysema may be resolved with the use of “fish gill” incisions at the lateral palpebromalar groove and simple drains. To the best of our knowledge, this method has not been reported previously in the literature.
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Affiliation(s)
- Manal Irshad Ahmed Patel
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, UK
| | - Anthony Barabas
- Department of Plastic Surgery, Hinchingbrooke Hospital, Huntingdon, Cambridgeshire, UK
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13
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Ali RK, Kakamad FH, Hama Ali Abdalla S, Hussein SI, Salih AM, Salih RQ, Mohammed SH, Hussien DA, Hassan MN, Abdulla BA, Abdullah HO, Othman S, Mikael TMSM. Management of post lobectomy subcutaneous emphysema; a case report with literature review. Ann Med Surg (Lond) 2021; 69:102610. [PMID: 34457249 PMCID: PMC8377524 DOI: 10.1016/j.amsu.2021.102610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/19/2021] [Accepted: 07/25/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Subcutaneous emphysema is an extremely rare complication after lobectomy. The current study aims to report a case of lung cancer developing extensive subcutaneous emphysema after lobectomy. Case presentation A 73-year-old man presented with dyspnea and cough for one month duration associated with wheeze and sputum. He was a chronic heavy smoker (100 pack/year). Work up revealed squamous cell carcinoma. Although he had poor pulmonary function tests, he underwent left upper lobectomy. On the fifth postoperative day, he was discharged from the hospital as there was no air leak and the lung remained expanded 15 hours after clamping of the thoracostomy tube. Two days later, the patient developed generalized subcutaneous emphysema. The patient was re-admitted to the hospital and a thoracostomy tube was inserted. The lung expanded upon insertion while the subcutaneous emphysema remained the same and even slightly increased over night. A 3 cm incision was made at the left infra-clavicular area and a negative pressure applied to it. The subcutaneous emphysema completely subsided a few hours after this intervention. Discussion Because of the benign course, the majority of cases of subcutaneous emphysema (mild to moderate) only need nonoperative management alongside treatment of the predisposing factors. These patients may need nothing other than bed rest, good analgesia, supplemental oxygen, and reassurance. Conclusion Subcutaneous emphysema after lobectomy prolongs hospital stay. It mainly occurs in cases with poor pulmonary function tests, steroid use, and those with extensive adhesion. Subcutaneous emphysema is one of the complications following thoracic surgery. Subcutaneous emphysema might be a benign and self-limiting condition. It might be a serious condition that ends with respiratory failure and death. In this report, a case of lung cancer developing subcutaneous emphysema after lobectomy discussed.
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Affiliation(s)
- Razhan K Ali
- Shar Hospital, College of Medicine, Sulaimani, Iraq
| | - Fahmi H Kakamad
- University of Sulaimani, Sulaimani, Iraq.,Smart Health Tower, Madam Mittarand Street, Sulaimani Iraq.,Kscien Organization, Hamdi Street, Azadi Mall, Sulaimani, Iraq
| | | | - Shakhawan I Hussein
- Smart Health Tower, Madam Mittarand Street, Sulaimani Iraq.,Kscien Organization, Hamdi Street, Azadi Mall, Sulaimani, Iraq
| | - Abdulwahid M Salih
- University of Sulaimani, Sulaimani, Iraq.,Smart Health Tower, Madam Mittarand Street, Sulaimani Iraq.,Kscien Organization, Hamdi Street, Azadi Mall, Sulaimani, Iraq
| | - Rawezh Q Salih
- Smart Health Tower, Madam Mittarand Street, Sulaimani Iraq.,Kscien Organization, Hamdi Street, Azadi Mall, Sulaimani, Iraq
| | | | - Dahat A Hussien
- Smart Health Tower, Madam Mittarand Street, Sulaimani Iraq.,Kscien Organization, Hamdi Street, Azadi Mall, Sulaimani, Iraq
| | - Marwan N Hassan
- University of Sulaimani, Sulaimani, Iraq.,Smart Health Tower, Madam Mittarand Street, Sulaimani Iraq.,Kscien Organization, Hamdi Street, Azadi Mall, Sulaimani, Iraq
| | - Berwn A Abdulla
- Smart Health Tower, Madam Mittarand Street, Sulaimani Iraq.,Kscien Organization, Hamdi Street, Azadi Mall, Sulaimani, Iraq
| | - Hiwa O Abdullah
- Smart Health Tower, Madam Mittarand Street, Sulaimani Iraq.,Kscien Organization, Hamdi Street, Azadi Mall, Sulaimani, Iraq
| | - Snur Othman
- Kscien Organization, Hamdi Street, Azadi Mall, Sulaimani, Iraq
| | - Tomas M Sharif M Mikael
- Smart Health Tower, Madam Mittarand Street, Sulaimani Iraq.,Kscien Organization, Hamdi Street, Azadi Mall, Sulaimani, Iraq
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14
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Sahu AK, Thandar S, Mathew R. Elderly man with subcutaneous emphysema. Emerg Med J 2021; 38:629-652. [PMID: 34449431 DOI: 10.1136/emermed-2020-210480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Ankit Kumar Sahu
- Department of Emergency Medicine, All India institute of Medical Sciences, New Delhi, India
| | - Soumitra Thandar
- Department of Emergency Medicine, All India institute of Medical Sciences, New Delhi, India
| | - Roshan Mathew
- Department of Emergency Medicine, All India institute of Medical Sciences, New Delhi, India
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15
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Melhorn J, Davies HE. The Management of Subcutaneous Emphysema in Pneumothorax: A Literature Review. CURRENT PULMONOLOGY REPORTS 2021. [DOI: 10.1007/s13665-021-00272-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Abstract
Purpose of Review
Subcutaneous emphysema is often observed by clinicians in the context of pneumothorax. It is usually clinically insignificant, but in a few cases can progress to threaten the patient’s vision or airway. A variety of approaches to management of such cases are described in the literature. There no controlled trials and no guidelines on management, other than that the cause should be identified and treated wherever possible. The goal of this article is to review the described approaches to subcutaneous emphysema in pneumothorax and provide a reference to the clinician.
Summary
Treatment can be directed primarily towards treating an underlying pneumothorax and / or towards the subcutaneous emphysema. These are not mutually exclusive approaches. Management of the underlying pneumothorax includes conservative management; use of negative suction; siting of wider bore intercostal drains and definitive surgical management. Management of subcutaneous emphysema may include decompression techniques such as: ‘blow hole’ incisions or subcutaneous angio-catheters or tunnelled drains.
In the current absence of controlled trials is not possible to comment on the efficacy of these techniques: no recommendations on management of subcutaneous emphysema in pneumothorax can be made. Management will be significantly influenced by local technical expertise and patient factors for the foreseeable future.
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Prakash M, Sharma V, Kang R, Meikle F. Airway compromise from subcutaneous emphysema. ANZ J Surg 2020; 91:E421-E422. [PMID: 33300213 DOI: 10.1111/ans.16477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 10/10/2020] [Accepted: 11/01/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Minesh Prakash
- Waikato Hospital Intensive Care Unit, Waikato District Health Board, Hamilton, New Zealand
| | - Varun Sharma
- Waikato Hospital Cardiothoracic Department, Waikato District Health Board, Hamilton, New Zealand
| | - Riley Kang
- Waikato Hospital Cardiothoracic Department, Waikato District Health Board, Hamilton, New Zealand
| | - Felicity Meikle
- Waikato Hospital Cardiothoracic Department, Waikato District Health Board, Hamilton, New Zealand
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Bouwmeester NH, Kieft H, Shahin GM, Nierich AP. A novel approach to resolve severe mediastinal and subcutaneous emphysema occurring in Pneumocystis jirovecii pneumonia using vacuum-assisted closure therapy. SAGE Open Med Case Rep 2020; 8:2050313X20918989. [PMID: 32477555 PMCID: PMC7233891 DOI: 10.1177/2050313x20918989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 03/18/2020] [Indexed: 11/15/2022] Open
Abstract
A 50-year-old human immunodeficiency virus positive patient who was diagnosed with Pneumocystis jirovecii pneumonia developed severe subcutaneous and mediastinal emphysema, which was progressive despite low pressure mechanical ventilation. Infraclavicular skin incisions and vacuum-assisted closure therapy were used to resolve the emphysema. The subcutaneous emphysema decreased significantly, and after 1 week the vacuum-assisted closure therapy was ended successfully. This technique has previously been described in several case reports, where it is a promising treatment in severe subcutaneous emphysema, but it is not yet widely used. This case report supports the further use of vacuum-assisted closure therapy in subcutaneous emphysema. Successful treatment of severe mediastinal and subcutaneous emphysema in Pneumocystis jirovecii pneumonia can be achieved by vacuum-assisted closure therapy on infraclavicular skin incisions.
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Affiliation(s)
| | - Hans Kieft
- Department of Intensive Care, Isala, Zwolle, The Netherlands
| | - Ghada Mm Shahin
- Department of Cardiothoracic Surgery, Isala, Zwolle, The Netherlands
| | - Arno P Nierich
- Department of Cardiothoracic Anesthesiology, Isala, Zwolle, The Netherlands
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Benyan AS, Medvedchikov-Ardiya MA, Shcherbakov DA. [Vac-therapy in the management of tension pneumomediastinum and subcutaneous emphysema]. Khirurgiia (Mosk) 2020:77-80. [PMID: 32352674 DOI: 10.17116/hirurgia202004177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pneumomediastinum and subcutaneous emphysema are the main manifestations of gas syndrome in patients with tracheal injury. Traditional mediastinal decompression in case of tension emphysema is carried out through different types of cervical or transpleural mediastinotomy and subsequent passive drainage. Clinical observation of the use of VAC-therapy in the patient with injury of the membranous part of trachea followed by tension pneumomediastinum is presented. Cervicotomy with dissection of anterior mediastinum and installation of vacuum-assisted dressing were performed. Fast regression of subcutaneous emphysema and relief of pneumomediastinum were noted. There were no complications. The patient was discharged in 6 days after admission. Effectiveness of VAC-therapy in patients with tension subcutaneous emphysema and pneumomediastinum was confirmed.
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Affiliation(s)
- A S Benyan
- Seredavin Samara Regional Clinical Hospital, Samara, Russia
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DeCato TW, Burk RE, Mir-Kasimov M, Shigeoka JW, Hegewald MJ, Sanders K. A 73-Year-Old Man With Progressive Whole Body Subcutaneous Gas After Pleural Catheter Removal. Chest 2020; 155:e97-e100. [PMID: 30955587 DOI: 10.1016/j.chest.2018.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 08/30/2018] [Accepted: 09/24/2018] [Indexed: 11/16/2022] Open
Abstract
CASE PRESENTATION A 73-year-old man presented to the ED of an outside hospital with asymptomatic chest wall swelling 10 h after discharge from our hospital. Four days earlier, he had presented to our hospital with increased dyspnea, cough, and sputum production. His history was notable for severe COPD with bullous emphysema. Chest imaging demonstrated bilateral opacities and a collection of gas and liquid in the major fissure of the left lung. A catheter was placed into the collection of gas and liquid under imaging guidance. After 4 days, the catheter was removed without event and the patient was discharged from the hospital with an extended course of antibiotics. Imaging performed in the ED revealed gas in the tissues of the chest wall and no evidence of a pneumothorax. He was transported back to our hospital by helicopter.
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Affiliation(s)
- Thomas W DeCato
- Department of Medical Education & Clinical Sciences, Washington State University Elson S. Floyd College of Medicine, Spokane, WA; Pulmonary Medicine, Providence Medical Group, Spokane, WA.
| | - Rebecca E Burk
- Division of Respiratory, Critical Care, & Occupational Pulmonary Medicine, University of Utah, Salt Lake City, UT
| | - Mustafa Mir-Kasimov
- Division of Respiratory, Critical Care, & Occupational Pulmonary Medicine, University of Utah, Salt Lake City, UT; George E. Wahlen VA Medical Center, Salt Lake City, UT
| | - John W Shigeoka
- Division of Respiratory, Critical Care, & Occupational Pulmonary Medicine, University of Utah, Salt Lake City, UT; George E. Wahlen VA Medical Center, Salt Lake City, UT
| | - Matthew J Hegewald
- Division of Respiratory, Critical Care, & Occupational Pulmonary Medicine, University of Utah, Salt Lake City, UT; Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, UT
| | - Karl Sanders
- Division of Respiratory, Critical Care, & Occupational Pulmonary Medicine, University of Utah, Salt Lake City, UT; George E. Wahlen VA Medical Center, Salt Lake City, UT
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Muszalski C, McKinnon S, Wilcox SR. Massive Subcutaneous Emphysema Leading to Airway Distortion. J Emerg Med 2019; 57:877-879. [PMID: 31653531 DOI: 10.1016/j.jemermed.2019.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/24/2019] [Accepted: 09/13/2019] [Indexed: 11/25/2022]
Affiliation(s)
| | | | - Susan R Wilcox
- Boston MedFlight, Bedford, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
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Machairas N, Paspala A, Syllaios A, Schizas D. Massive subcutaneous emphysema after traumatic pneumothorax. Clin Case Rep 2019; 7:1789-1790. [PMID: 31534751 PMCID: PMC6745444 DOI: 10.1002/ccr3.2311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 05/16/2019] [Accepted: 06/27/2019] [Indexed: 11/22/2022] Open
Abstract
A simple case/asymptomatic pneumothorax not deemed to necessitate drainage can quickly change, and patient safety can be compromised. Chest tube insertion with increased suction is considered a safe and efficient strategy in patients with extensive subcutaneous emphysema following traumatic pneumothorax.
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Affiliation(s)
- Nikolaos Machairas
- Third Department of Surgery, Attikon University HospitalNational and Kapodistrian University of AthensAthensGreece
| | - Anna Paspala
- Third Department of Surgery, Attikon University HospitalNational and Kapodistrian University of AthensAthensGreece
| | - Athanasios Syllaios
- First Department of Surgery, Laikon HospitalNational and Kapodistrian University of AthensAthensGreece
| | - Dimitrios Schizas
- First Department of Surgery, Laikon HospitalNational and Kapodistrian University of AthensAthensGreece
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Sindi D, Mirza A, Khirallah MG, Bustangi NM. Management of extensive subcutaneous emphysema using vacuum-assisted closure therapy. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2019.101272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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[Postoperative complications after major lung resection]. Rev Mal Respir 2019; 36:720-737. [PMID: 31208887 DOI: 10.1016/j.rmr.2018.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 09/08/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The advent of the minimally invasive techniques has allowed an expansion of the indications for thoracic surgery, particularly in older patients and those with more comorbidities. However, the rate of postoperative complications has remained stable. STATE OF THE ART Postoperative complications are defined as any variation from the normal course. They occur in 30% but majority of them are minor. The 30-day mortality rate for lung resection varies range between 2 % and 3% in the literature. Complications can be classified as: (1) early (occurring in the first 24hours) including both "generic" surgical complications (especially postoperative bleeding) and complications more specific to lung surgery (Acute respiratory syndrome, atelectasis); (2) in-hospital complications and those occurring during the first 3 months; these are dominated by infectious events in particular pneumonia but also bronchial (bronchopleural fistula), pleural (pneumothorax, hydrothorax) or cardiac complications; (3) late complications are dominated by chronic pain, affecting 60% of patients having a thoracotomy at three months. Lobectomy is the most common lung resection. Pneumonectomy is a distinct procedure requiring a specific peri- and postoperative management. Right pneumonectomy is associated with a higher risk with a treatment related-mortality ranging between 7 and 10%. CONCLUSION Major lung resection has benefited from minimally invasive approaches and fast track to surgery. However, it is important to note the occurrence of new and specific complications related to those news surgical access.
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Ema T, Neyatani H, Yamamoto S, Iizuka S, Funai K, Shiiya N. Computed tomography-guided tube thoracostomy for massive subcutaneous emphysema following lung resection: a case report. AME Case Rep 2019; 3:11. [PMID: 31119212 DOI: 10.21037/acr.2019.04.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 04/04/2019] [Indexed: 11/06/2022]
Abstract
A 70-year-old man underwent right-sided pulmonary bilobectomy (removal of the middle and lower lobes) for stage IIIA non-small-cell lung carcinoma. Following the operation, there was minor air leakage through the intercostal drain from postoperative day 0 to 2, which stopped completely by postoperative day 3. The subsequent postoperative course was uneventful, and the patient was discharged on postoperative day 7 after removal of the chest tube. On postoperative day 9, the patient returned to the hospital with complaints of nasal speech and bulging of the skin over his right breast region. He was diagnosed with postoperative subcutaneous emphysema. A chest computed tomography (CT) scan revealed that the emphysema was not associated with a collapsed lung, and the patient's relatively small-sized thoracic cavity left limited space for the placement of a chest tube. We performed a CT-guided tube thoracostomy with proper insertion and placement of an intercostal drain at the site of the air leakage, within the compact thoracic cavity. The procedure was effective in draining the trapped air, thus resolving the subcutaneous emphysema successfully.
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Affiliation(s)
- Toshinari Ema
- Department of Thoracic Surgery, Fujieda Municipal General Hospital, Shizuoka, Japan
| | - Hiroshi Neyatani
- Department of Thoracic Surgery, Fujieda Municipal General Hospital, Shizuoka, Japan
| | - Saki Yamamoto
- Department of Thoracic Surgery, Fujieda Municipal General Hospital, Shizuoka, Japan
| | - Shuhei Iizuka
- Department of Thoracic Surgery, Fujieda Municipal General Hospital, Shizuoka, Japan
| | - Kazuhito Funai
- First Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
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A Case Report of Acute Airway Compromise due to Subcutaneous Emphysema. Case Rep Med 2018; 2018:3103061. [PMID: 30595698 PMCID: PMC6286736 DOI: 10.1155/2018/3103061] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/26/2018] [Accepted: 11/11/2018] [Indexed: 12/29/2022] Open
Abstract
In the acute management of a trauma patient, airway patency is of utmost importance. The present case describes a male patient who presented with delayed severe upper airway obstruction secondary to massive subcutaneous emphysema following blunt traumatic injury two days previously. Airway compromise is a rarely described but serious complication of subcutaneous emphysema. Current management of subcutaneous emphysema and its association with pneumothorax is summarized. Early decompression of underlying pneumothoraces in patients with significant subcutaneous emphysema should be performed to avoid this rare complication.
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26
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Robinson B. Rapid resolution of severe subcutaneous emphysema with simple percutaneous angiocatheter decompression. J Surg Case Rep 2018; 2018:rjy173. [PMID: 30046438 PMCID: PMC6054200 DOI: 10.1093/jscr/rjy173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 06/29/2018] [Indexed: 11/13/2022] Open
Abstract
Subcutaneous emphysema (SE) is often seen as a sequela of chest tube placement, cardiothoracic surgery, trauma, pneumothorax, infection or malignancy. In most cases SE is self-limited and requires no intervention. Rarely, air can rapidly dissect into subcutaneous tissue planes leading to respiratory distress, patient discomfort and airway compromise. This is a case of a 75-year-old woman that developed massive SE and impending respiratory failure with rapid progression of air into her subcutaneous tissue. In an effort to rapidly stabilize the patient we placed multiple percutaneous angiocatheters into the subfascial space with complete resolution in <24 h. This technique was an excellent temporizing measure and found to be superior to previously described techniques involving large open ‘blow hole’ incisions or large bore drains. Placement of angiocatheter needles for the decompression of subcutaneous air is a well-tolerated, readily accessibility, low cost and simple procedure for the treatment of SE.
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Affiliation(s)
- Brenton Robinson
- Department of Surgery, Saint Joseph Hospital, 2900 North Lake Shore Drive, Chicago, IL, USA
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Tran Q, Mizumoto R, Mehanna D. Management of extensive surgical emphysema with subcutaneous drain: A case report. Int J Surg Case Rep 2018; 44:126-130. [PMID: 29501016 PMCID: PMC5910498 DOI: 10.1016/j.ijscr.2018.01.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/04/2018] [Accepted: 01/29/2018] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Subcutaneous emphysema (SE) is a frequent and often self-limiting complication of tube thoracostomy or other cardiothoracic procedures. On rare occasions, severe and extensive surgical emphysema marked by palpable cutaneous tension, dysphagia, dysphonia, palpebral closure or associated with pneumoperitoneum, airway compromise, "tension phenomenon" and respiratory failure require treatment. PRESENTATION OF CASE A 67 year old lady presented with a large spontaneous pneumothorax on the background of end-stage chronic obstructive pulmonary disease (COPD) and newly diagnosed lung cancer, developed extensive surgical emphysema following insertion of a chest drain. Immediate improvement was observed after insertion of a large-bore, 26 French (Fr.) intercostal catheter, subcutaneous drain which was maintained under low suction (-5 cm H2O) for a further 24 h. DISCUSSION Several methods have been described in the literature for the treatment of extensive subcutaneous emphysema, including: emergency tracheostomy, multisite subcutaneous drainage, infraclavicular "blow holes" incisions and subcutaneous drains or simply increasing suction on an in situ chest drain. Here a large-bore, fenestrated, subcutaneous drain maintained on low negative pressure also provided the necessary decompression. CONCLUSION In the absence of a comparative study to identify the most effective method to manage extensive subcutaneous emphysema, this case highlights an effective, simple and safe management option.
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Affiliation(s)
- Quoc Tran
- Department of General Surgery, Caboolture Hospital, Caboolture, Australia.
| | - Ryo Mizumoto
- Department of General Surgery, Caboolture Hospital, Caboolture, Australia; School of Medicine, University of Queensland, St Lucia, Queensland, Australia
| | - Daniel Mehanna
- Department of General Surgery, Caboolture Hospital, Caboolture, Australia
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Abstract
Clinical suspicion of hemo/pneumothorax: when in doubt, drain the chest. Stable chest trauma with hemo/pneumothorax: drain and wait. Unstable patient with dislocated trachea must be approached with drain in hand and scalpel ready. Massive hemo/pneumothorax may be controlled by drainage alone. The surgeon should not hesitate to open the chest if too much blood drains over a short period. The chest drainage procedure does not end with the last stitch; the second half of the match is still ahead. The drained patient is in need of physiotherapy and proper pain relief with an extended pleural space: control the suction system.
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Affiliation(s)
- Tamas F Molnar
- Department of Operational Medicine, Faculty of Medicine, University of Pécs, H7622 Pécs, Szigeti út 12, Hungary; Thoracic Surgery Unit, Department of Surgery, Aladar Petz Teaching Hospital, H9032 Győr, Vasvari Pál utca 2-4, Hungary.
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Ahmed Z, Patel P, Singh S, Sharma RG, Somani P, Gouri AR, Singh S. High negative pressure subcutaneous suction drain for managing debilitating subcutaneous emphysema secondary to tube thoracostomy for an iatrogenic post computed tomography guided transthoracic needle biopsy pneumothorax: Case report and review of literature. Int J Surg Case Rep 2016; 26:138-41. [PMID: 27494369 PMCID: PMC4976133 DOI: 10.1016/j.ijscr.2016.07.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/22/2016] [Accepted: 07/22/2016] [Indexed: 11/28/2022] Open
Abstract
Iatrogenic pneumothorax should be anticipated during and after a CT guided transthoracic needle biopsy and actively treated. Chest tube malposition is a common complication of tube thoracostomy. Chest tubes should always be inserted in the triangle of safety described by the British thoracic society. Debilitating subcutaneous emphysema which causes distress, anxiety, palpebral closure, dyspnoea or dysphagia requires intervention. High negative pressure subcutaneous suction drains provide immediate and sustained relief in extensive and debilitating SE.
Introduction Subcutaneous emphysema is a common complication of tube thoracostomy. Though self-limiting, it should be treated when it causes palpebral closure, dyspnea, dysphagia or undue disfigurement resulting in anxiety and distress to the patient. Presentation of case A 72 year old man who was a known case of COPD on bronchodilators developed a large pneumothorax and respiratory distress after a CT guided transthoracic lung biopsy done for a lung opacity (approx. 3 × 3 cm) at the right hilar region on Chest X-ray. Within 24 h of an urgent tube thoracostomy, patient developed intractable subcutaneous emphysema with closure of palpebral fissure and dyspnea unresponsive to increasing suction on chest tube. A subcutaneous fenestrated drain was placed mid-way between the nipple and clavicle in the mid-clavicular line bilaterally. Continuous negative suction (-150 mmHg) resulted in immediate, sustained relief and complete resolution within 5 days. Discussion Extensive and debilitating SE (subcutaneous emphysema) has to be treated promptly to relieve patient discomfort, dysphagia or imminent respiratory compromise. A variety of treatment have been tried including infraclavicular blow-hole incisions, subcutaneous drains +/− negative pressure suction, fenestrated angiocatheters, Vacuum assisted dressings and increasing suction on a pre-existing chest tube. We describe a high negative pressure subcutaneous suction drain which provides immediate and sustained relief in debilitating SE. Conclusion Debilitating subcutaneous emphysema which causes distress, anxiety, palpebral closure, dyspnoea or dysphagia requires intervention. High negative pressure subcutaneous suction drain provides immediate and sustained relief in extensive and debilitating SE.
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Affiliation(s)
- Zeeshan Ahmed
- Department of Surgical Oncology, SMS Medical College and Hospital, JLN Marg, Jaipur, 302004, Rajasthan, India.
| | - Pinakin Patel
- Department of Surgical Oncology, SMS Medical College and Hospital, JLN Marg, Jaipur, 302004, Rajasthan, India.
| | - Suresh Singh
- Department of Surgical Oncology, SMS Medical College and Hospital, JLN Marg, Jaipur, 302004, Rajasthan, India.
| | - Raj Govind Sharma
- Department of Surgical Oncology, SMS Medical College and Hospital, JLN Marg, Jaipur, 302004, Rajasthan, India.
| | - Pankaj Somani
- Department of Surgical Oncology, SMS Medical College and Hospital, JLN Marg, Jaipur, 302004, Rajasthan, India.
| | - Abdul Rauf Gouri
- Department of Surgical Oncology, SMS Medical College and Hospital, JLN Marg, Jaipur, 302004, Rajasthan, India.
| | - Shiv Singh
- Department of Surgical Oncology, SMS Medical College and Hospital, JLN Marg, Jaipur, 302004, Rajasthan, India.
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Pitukweerakul S, Pilla S. Massive Subcutaneous Emphysema. J Gen Intern Med 2016; 31:700-1. [PMID: 26892319 PMCID: PMC4870413 DOI: 10.1007/s11606-015-3581-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 08/17/2015] [Accepted: 12/16/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Siwadon Pitukweerakul
- Department of Medicine, Presence Saint Francis Hospital, 355 Ridge avenue, Evanston, IL, 60202, USA.
| | - Sree Pilla
- Department of Medicine, Presence Saint Francis Hospital, 355 Ridge avenue, Evanston, IL, 60202, USA
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García Del Moral RM, Martín-López J, Arias-Díaz M, Díaz-Castellanos MA. Treatment of massive subcutaneous emphysema with aspiration drainage. Med Intensiva 2015; 40:253-4. [PMID: 26560018 DOI: 10.1016/j.medin.2015.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 09/01/2015] [Accepted: 09/02/2015] [Indexed: 10/22/2022]
Affiliation(s)
- R M García Del Moral
- Unidad de Cuidados Intensivos, Hospital Santa Ana, Área de Gestión Sur de Granada, Motril, Granada, España.
| | - J Martín-López
- Unidad de Cuidados Intensivos, Hospital Santa Ana, Área de Gestión Sur de Granada, Motril, Granada, España
| | - M Arias-Díaz
- Unidad de Cuidados Intensivos, Hospital Santa Ana, Área de Gestión Sur de Granada, Motril, Granada, España
| | - M A Díaz-Castellanos
- Unidad de Cuidados Intensivos, Hospital Santa Ana, Área de Gestión Sur de Granada, Motril, Granada, España
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Son BS, Lee S, Cho WH, Hwang JJ, Kim KD, Kim DH. Modified blowhole skin incision using negative pressure wound therapy in the treatment of ventilator-related severe subcutaneous emphysema. Interact Cardiovasc Thorac Surg 2014; 19:904-7. [PMID: 25164135 DOI: 10.1093/icvts/ivu287] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES A 2-3-cm blowhole incision in the supraclavicular or infraclavicular area is widely used to eliminate the presence of subcutaneous air in cases of life-threatening subcutaneous emphysema (SE). However, when the patient is supported by mechanical ventilation, it is difficult to eliminate completely such air because mechanical ventilation leads consistently to the formation of large amounts of air. To overcome this, we applied negative pressure wound therapy (NPWT) along with blowhole incisions for the treatment of severe SE. METHODS To evaluate the feasibility of NPWT, we retrospectively analysed the clinical outcomes of 10 patients who developed severe SE during ventilator care and were treated with a modified blowhole incision using NPWT from January 2009 to November 2013. RESULTS All patients showed immediate improvement in SE after NPWT, and no symptom aggravation occurred after NPWT. The mean duration of NPWT was 7.5 ± 5.1 (range, 3-14) days, and the mean number of dressing changes was 1.5 ± 0.7 (range, 1-2). There were no blowhole-incision-related wound infections or any other complications. CONCLUSIONS While it is not necessary to apply a blowhole incision with NPWT in all cases of SE, this therapy can be helpful for patients with severe SE associated with mechanical ventilation requiring rapid decompression.
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Affiliation(s)
- Bong Soo Son
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Sungsoo Lee
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, South Korea
| | - Woo Hyun Cho
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Jung Joo Hwang
- Department of Thoracic and Cardiovascular Surgery, Eulji University Hospital, Daejeon, South Korea
| | - Kil Dong Kim
- Department of Thoracic and Cardiovascular Surgery, Eulji University Hospital, Daejeon, South Korea
| | - Do Hyung Kim
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Yangsan, South Korea
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Hajj-Chahine J. eComment. Multisite drainage of extensive subcutaneous emphysema. Interact Cardiovasc Thorac Surg 2014; 18:829. [PMID: 24842980 DOI: 10.1093/icvts/ivu091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jamil Hajj-Chahine
- Department of Cardio-Thoracic Surgery, University Hospital of Poitiers, Poitiers, France
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