Massive Traumatic Subcutaneous Emphysema

Pneumoscrotum with extensive subcutaneous emphysema in traumatic perineal injury: A case report

Key Clinical Message

We present a rare case of pneumoscrotum with subsequent subcutaneous emphysema in penetrating perineal injury with a tangential wound. It is important to diagnose the underlying disease and treat the cause. An examination under anesthesia is crucial for the diagnosis and management of the set of injuries.

Abstract

Pneumoscrotum with subcutaneous emphysema in traumatic perineal injuries is an alarming sign and may indicate life-threatening intraabdominal injuries or necrotizing fasciitis. We reported a case of pneumoscrotum and extensive subcutaneous emphysema of the abdomen and chest 2 days after admission. Pneumoscrotum was not seen on the initial Computerized tomographic scan.

[Spontaneous pneumomediastinum]

INTRODUCTION

Pneumomediastinum, which can be spontaneous or secondary, is defined by the presence of free air in the mediastinum as shown on a chest X-ray and/or chest CT, with or without subcutaneous emphysema. Secondary pneumomediastinum develops in various contexts (thoracic traumatism, perforation of central airway or digestive tract, pneumothorax, barotraumatism complicating mechanical ventilation…). Spontaneous pneumomediastinum , which will be the focus of this review, develops without any of the above-mentioned conditions.

STATE OF ART

Spontaneous pneumomediastinum is a rare entity which usually occurs in young people either without medical history or with an history of asthma. A trigger event is detected in 40% to 60% of cases. Positive diagnosis is made on chest radiographt but thoracic CT is more sensitive. Distinction between spontaneous pneumomediastinum and secondary pneumomediastinum is in general easy but may sometimes be more difficult, particularly in case of oesophageal perforation. The evolution of spontaneous pneumomediastinum is most often benign but, rare complications may occur. Management is most often conservative.

PERSPECTIVES

There is no consensual management of spontaneous pneumediastinum because of the lack of randomized prospective studies. This may be explained by the rarity of the disease. The actual trend is to offer to the patients a conservative treatment, which could be ambulatory in some cases.

CONCLUSIONS

Spontaneous pneumomediastinum is a rare entity developing mainly in young subjects. The evolution is in general benign, justifying a conservative approach.