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Extensive Case of Subcutaneous Emphysema

  • Desirae M. Budi and Christopher Palmer
Published/Copyright: October 1, 2015
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Journal of Osteopathic Medicine
From the journal Journal of Osteopathic Medicine Volume 115 Issue 10

A67-year-old man with no medical history presented to the emergency department with dyspnea and chest swelling, which developed after he fell on ice. His symptoms progressed in the emergency department to dysphonia and dysphagia with extensive facial swelling. A chest radiograph and computed tomographic scan showed subcutaneous emphysema, pneumomediastinum (image A), and hemopneumothorax with displaced rib fracture (image B). Subcutaneous emphysema manifests as painless tissue swelling secondary to air tracking along fascia into areas of least resistance.1 Chest and gastrointestinal trauma and infections can be sources of air leakage.2 Clinical signs include dysphagia, dyspnea, dysphonia, and crepitus. The patient’s crepitus extended from his cranial vertex to his knees, with popping sensations on palpation generated by air bubbles bursting under the pressure. Crepitus is often benign and self-limited until the patient’s breathing or blood supply becomes affected by the swelling, at which point surgically placed catheters are required.3 A chest tube was placed, preventing air from entering the subcutaneous space. On day 6, the chest tube was removed and the patient was discharged home on day 7.

From the Department of Internal Medicine at Kent Hospital in Warwick, Rhode Island.

*Address correspondence to Desirae M. Budi, DO, 455 Toll Gate Rd, Warwick, RI 02886-2759. E-mail:

References

1. Frias Vilaça A ,ReisAM,VidalIM. The anatomical compartments and their connections as demonstrated by ectopic air.Insights into Imaging.2013;4(6):759-772. doi:10.1007/s13244-013-0278-0.10.1007/s13244-013-0278-0Search in Google Scholar PubMed PubMed Central

2. Eckstein M ,HendersonSO. Thoracic trauma. In: MarxJ, ed.Rosen’s Emergency Medicine: Concepts and Clinical Practice. 8th ed.Philadelphia, PA: Saunders. 2013.10.1016/B978-0-323-05472-0.00042-6Search in Google Scholar

3. Bodenham A ,ParamasivamE. Air leaks, pneumothorax, and chest drains.Contin Educ Anaesth Crit Care Pain.2008;8(6):204-209.10.1093/bjaceaccp/mkn038Search in Google Scholar
Accepted: 2015-04-22
Published Online: 2015-10-01
Published in Print: 2015-10-01

© 2015 American Osteopathic Association

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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https://doi.org/10.7556/jaoa.2015.131
Creative Commons
BY-NC-ND 4.0

Articles in the same Issue

  1. SURF
  2. Effects of Stem Cell Treatment in Human Patients With Peyronie Disease
  3. IN MY VIEW
  4. Interstate Medical Licensure Compact: Pernicious Myths and Inescapable Facts
  5. ORIGINAL CONTRIBUTION
  6. Accuracy and Adequacy of Computed Tomography–Guided Lung Biopsies: Experience From a Community Hospital
  7. Quantification of Motion Palpation
  8. REVIEW
  9. Non–Vitamin K Antagonist Oral Anticoagulants: The Clinician’s New Challenge
  10. CASE REPORT
  11. Peroneus Longus Rupture at Its Origin Managed With Platelet Rich Plasma
  12. THE SOMATIC CONNECTION
  13. 2b or not 2b: The State of the Evidence for Myofascial Release
  14. Lymphatic Vessels Found in the Brain—Osteopathic Considerations
  15. Osteopathic Manipulative Therapy Efficacious for Patients With Chronic Migraines
  16. Ultrasound Measurement of Vertebral Artery Blood Flow Before and After High-Velocity, Low-Amplitude Thrust Therapy
  17. Osteopathic Manipulative Therapy Shows Promise for Improving Postdiskectomy Recovery
  18. Bodywork Shown to Reduce the Symptoms of Chronic Constipation and Improve Quality of Life
  19. CLINICAL IMAGES
  20. Extensive Case of Subcutaneous Emphysema
  21. IN YOUR WORDS
  22. Filling an Open Spot
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