Diffuse Subcutaneous Emphysema Research Articles

Surgical emphysema and pneumothorax: Unfamiliar combination in Ehlers-Danlos syndrome

A 53-year-old gentleman presented with sudden onset swelling over the neck for the past 5 days. It was associated with dyspnoea on exertion. He was a known patient of Ehlers-Danlos syndrome since sixteen years of age. Initially, the swelling appeared over the neck which gradually progressed over to the anterior chest wall and the nape of the neck. There was no history of trauma, fever, surgery or similar complaints in the past. He was a known smoker. On examination, there was diffuse subcutaneous emphysema over the neck, and the anterior chest wall (Figure 1). Skin crepitus was present. The skin was hyper-extensile, fragile and easily stretchable (Figure 1). The patient was vitally stable. On rigid laryngoscopy, bilateral vocal cords were mobile. We admitted the patient and performed a CT scan of the neck and chest to assess the extent of the emphysema. CT scan confirmed an extensive subcutaneous emphysema over the neck, extending posterior to the oesophagus. There were multiple emphysematous bullae over the apical region of the right lung and an area of pneumothorax just in the vicinity of the bullae (Figure 2). The patient was planned for incision and evacuation of the air. A horizontal incision was given over the most prominent part of the swelling and the air was milked out gently. An Intercostal Chest Drain (ICD) was inserted and the condition was closely monitored. The recovery was uneventful. He was discharged after seven days of hospital stay.

Pneumoscrotum: Case Series & Literature Review

Pneumoscrotum is the terminology used to describe the presence of air in the scrotal wall or within the tunica vaginalis. Etiology of pneumoscrotum is varied, ranging from idiopathic to Fournier’s gangrene or perforated bowel leading to significant morbidity and mortality. This paper reviews the existing literature on pneumoscrotum whilst documenting our experience with the same. Diagnosis is dependent on the patient’s anamnesis, clinical signs and imaging. We are presenting a case series of three such cases and a review of the existing literature on the same. The first case is a victim of a road traffic accident who subsequently presented with diffuse subcutaneous emphysema involving the scrotum. The second case is of Fournier’s gangrene with pneumoscrotum. The third case presented with a spontaneous isolated pneumoscrotum without any cause. Imaging such as Contrast-Enhanced CT and USG may be done to help narrow the differentials.

Successful treatment of rapidly progressive interstitial lung disease complicated by a refractory pneumomediastinum in a patient with anti‐MDA5 antibody‐positive dermatomyositis

AbstractIntroductionAnti‐melanoma differentiation‐associated gene 5‐positive dermatomyositis (anti‐MDA5+ DM) is a distinct subtype of DM, which is characterized by typical cutaneous features, minimal or no muscle involvement and notable interstitial lung disease, which typically progresses rapidly and has a high mortality. Spontaneous pneumomediastinum (PNM), a relatively unusual but serious complication of anti‐MDA5+ DM, further increases mortality. Currently, there is no generally accepted treatment regimen for anti‐MDA5+ DM‐associated PNM.Case DescriptionA 53‐year‐old man with anti‐MDA5+ DM presented with rapidly progressive interstitial lung disease that progressed to diffuse subcutaneous emphysema and PNM despite aggressive immunosuppressive therapies. He responded well to combined anti‐infection treatments, moderate immunotherapy, and continuous oxygen therapy.ConclusionComprehensive screening for potential infections, as well as close monitoring of the patient's immune status is essential for individualizing treatment and maximizing prognosis.

Severe respiratory distress secondary to pharyngeal perforation during endoscopic gastrostomy tube removal: a clinical case report

We present the case of a 60-year-old patient with advanced chronic obstructive pulmonary disease (COPD), who presented for planned endoscopic removal of her gastrostomy feeding tube, which was inserted for nutritional status optimization prior to lung transplantation. The procedure was complicated by accidental blockage of the device at the pharyngeal level, causing a transmural laceration. Rapid respiratory distress developed with subcutaneous emphysema that led to the intubation of the patient. A new endoscopic retrieval was attempted but failed, and the patient was sent to the operating room after a cervical and thoracic CT scan that showed the blocked piece in the cervical wall, in addition to diffuse subcutaneous emphysema, a large pneumomediastinum, and a left pneumothorax. The surgery consisted of a left cervicotomy, a pharyngeal incision, and retrieval of the trapped parts. The patient was sent to the intensive care unit (ICU) where she could be weaned and extubated 1 week later.

PNEUMORACHIS FROM ASTHMA EXACERBATION: A RARE COMPLICATION

PNEUMORACHIS FROM ASTHMA EXACERBATION: A RARE COMPLICATION

Spontaneous bilateral pneumothorax and pneumomediastinum independent of mechanical ventilation as complications of COVID-19 pneumonia: A case report.

Since the beginning of the COVID-19 pandemic, several infected patients have suffered from unusual and severe complications. Among these rare complications, pneumothorax and pneumomediastinum have attracted clinical attention. Such complications might be challenging to diagnose immediately because of the atypical presentation in some cases. Accurate diagnosis is essential to ensure effective treatment. Here, we present the case of a 62-year-old male who presented with symptoms of COVID-19 acute respiratory distress. There was diffuse subcutaneous emphysema in the face, neck, shoulder, and chest wall on clinical examination. The patient was started on oxygenation via a non-rebreather mask. On further evaluation, his chest X-ray revealed bilateral peripheral opacities in the lung fields, bilateral pneumothorax, and subcutaneous emphysema, after which intercostal drainage tubes were inserted. The patient's oxygen saturation was not satisfactory, and he was switched to a high-flow nasal cannula. However, his condition deteriorated, and he was put on mechanical ventilation and inotropic support. Despite our best efforts, the patient succumbed to the disease. We want to emphasize the importance of this adverse event despite his nonsmoking history and the exclusion of positive pressure ventilation. Although benign, early diagnosis of this condition is vital, as the condition could lead to worse morbidity if left unrecognized.

A Rare Case of Ulcerative Colitis with Diffuse Parenchymal Lung Disease, Spontaneous Pneumomediastinum and Subcutaneous Emphysema

A 50-year-old male, a tobacco smoker, who was known to have ulcerative colitis presented with dry cough, chest pain, dysponea and frequent passage of blood and mucous mixed stools. Physical examination revealed clubbing, subcutaneous emphysema of upper chest and auscultatory findings of crunching sound over pre-cordial area and basal crepitations. Spirometry was suggestive of restrictive pattern. High resolution computed tomography (HRCT) of thorax revealed pneumomediastinum, subcutaneous emphysema, bilateral diffuse centrilobular nodules and ground-glass haziness with mosaic pattern along with posterior basal fibrotic changes. The present case documents the uncommon pulmonary involvement of spontaneous pneumomediastinum and subcutaneous emphysema diffuse parenchymal lung disease, in a patient with ulcerative colitis.

Spontaneous Pneumomediastinum, Pneumoperitoneum, and Subcutaneous Emphysema beyond the Inguinal Ligament Secondary to Inversion Maneuvers

Pneumomediastinum is free air within the mediastinal cavity which can spread along tissue planes leading to the accumulation of large amounts of subcutaneous emphysema. Patient is a 21-year-old male with a history of autism spectrum disorder and rhabdomyolysis who presented with diffuse “popping under the skin” and was found to have crepitus extending from his neck to his bilateral ankles. He exercises frequently and performs chin-up pullovers and will often hold his breath during this movements. He uses an inversion table but denies any valsalva maneuvers or straining while inverted. Radiological imaging demonstrated pneumomediastinum, pneumoperitoneum, and diffuse subcutaneous emphysema extending into the pelvis. Diagnosis requires a combination of history, physical exam findings, and imaging findings. Patients with spontaneous pneumomediastinum typically experience self-limited disease, and efforts should be made to minimize low yield invasive testing. Most patients can be treated on an outpatient basis after monitoring and education about potential complications.

Traumatic Pneumopericardium and Diffuse Subcutaneous Emphysema in a Child- A Case Report and Review of the Literature

Pneumopericardium is defined as air inside the pericardial space. Pediatric pneumomediastinum and subcutaneous emphysema is an uncommon condition can occur due to various reasons : infection, trauma, foreign body aspiration, coexisting structural lung pathology or iatrogenic. It rarely happens after chest trauma. We are here to report a child 8 year old involved in a tackle during a recreational football game with clinically and radiologically affirmed pneumopericardium and diffuse sub cutaneous emphysema caused by chest trauma that was spontaneously relieved.

BRONCHOPLEURAL FISTULA POST LOBECTOMY: A RARE COMPLICATION WITH AN EVEN MORE UNUSUAL PRESENTATION

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: The formation of a bronchopleural fistula (BPF) is a rare but known complication following major thoracic surgery. In a study by Nachira et al. looking at 835 patients in Italy who underwent major lung resection, 786 patients underwent lobectomy with 11 (1.3%) developing a BPF [1]. In other studies their incidence has been reported between 0.5-3% [2]. Here we present a case of an unusual presentation of this rare complication. CASE PRESENTATION: 73 y.o F former smoker was incidentally found to have right upper lobe (RUL) chondral myxoid tumor. She underwent bronchoscopy and video assisted thoracoscopy (VATS) with wedge resection of RUL and placement of chest tube without peri-operative complications. Later that day, rapid response was called as patient developed facial swelling, sensation of throat tightening and upper chest erythema with subcutaneous emphysema (SCE) (Figure 1). Initial thought was possible anaphylaxis from NSAIDs and treated as such. Patient later further deteriorated leading to intubation and transfer to the ICU. Second right-sided chest tube and skin holes placed on chest for relief of subcutaneous air. Patient was extubated next day. Due to persistent SCE (Figure 2) and need for respiratory support, patient received bilateral blow-holes and was downgraded to surgical floor after improvement. Symptoms again recurred requiring re-intubation. Blow-holes were extended and 3rd right-sided chest tube placed. She was taken for repeat VATS and found to have a BPF with adhesions. Lysis of adhesions was performed with RUL mediastinal drainage and mechanical pleural abrasion. The rest of patient's hospital course was uncomplicated with eventual removal of chest tubes and discharge. DISCUSSION: As discussed, our patient had a complicated post-operative course, complicated further by the unique presentation of her BPF. We found no previous literature or case reports illustrating similar presenting symptoms of BPFs. They typically present 1 - 12 weeks postoperatively [2]. Our patient did not fit this timeline and had a very atypical presentation which mimicked symptoms of an anaphylactoid reaction. Although diffuse subcutaneous emphysema has been a reported finding from BPFs [3], this was thought to be a normal result of recent surgical procedure. This uncommon presentation led to delay in appropriate management and extended hospital course for this patient. CONCLUSIONS: This case demonstrates a unique presentation of a potentially fatal complication of major thoracic surgeries. BPF formation may need to be considered in patients who present similarly in the future. REFERENCE #1: Nachira D, Chiappetta M, Fuso L, Varone F, Leli I, Congedo MT, Margaritora S, Granone P. Analysis of risk factors in the development of bronchopleural fistula after major anatomic lung resection: experience of a single centre. ANZ J Surg.2018 Apr;88(4):322-326.doi: 10.1111/ans.13886. Epub 2017 Feb 1.PMID: 28147437. REFERENCE #2: Gaur P, Dunne R, Colson YL, Gill RR. Bronchopleural fistula and the role of contemporary imaging. J Thorac Cardiovasc Surg. 2014 Jul;148(1):341-7. doi: 10.1016/j.jtcvs.2013.11.009. Epub 2013 Dec 16. PMID: 24355543. REFERENCE #3: Anas Riehani, Olivia Wilcox, Wassim Mohammed Odeh, Michael Kehdi, and John Armstrong. Bronchopleural Fistula Presenting as diffuse Subcutaneous Emphysema. C46. PLEURAL DISEASE: CASE REPORTS II. May 1, 2017, A5647-A5647 DISCLOSURES: No relevant relationships by Inessa Bronshteyn, source=Web Response No relevant relationships by Kyle Foster, source=Web Response No relevant relationships by Janeen Grant-Sittol, source=Web Response No relevant relationships by Ross Lavine, source=Web Response No relevant relationships by Anna-Belle Robertson, source=Web Response

Mediastinal and subcutaneous emphysema after manual strangulation

Pneumomediastinum is a disease characterized by the presence of air in the mediastinum. The disease is examined in two categories as spontaneous and secondary and frequently seen as a result of traumatic causes. In our study, we present a case of diffuse mediastinal and subcutaneous emphysema after strangulation, unrelated to penetrating injury. After detailed anamnesis, it was understood that it was not a simple penetrating injury but a complicated trauma. Anamnesis, clinical findings, and radiology should be compatible with each other. When necessary, detailed anamnesis should be insisted and the etiology of blunt trauma should be investigated, especially if mediastinal emphysema is detected. Complications such as tension pneumomediastinum, pneumopericardium, and mediastinitis can be seen which complicates the disease and can result in death.

A serious fit of cough: A 66-year-old patient with myasthenia gravis presenting with spontaneous intercostal lung herniation after coughing. Case report and pathophysiological discussion

We present a case of a 66-year-old man with history of myasthenia gravis, severe obesity and osteopenia self-presented to our Emergency Department (ED) with severe pain in his left hemithorax, occurred after an episode of cough three days before. No history of trauma was reported. The patient underwent a chest-XR showing uncomplicated spontaneous fractures of the 5th and 6th left ribs. He was therefore discharged with appropriate analgesic treatment. Five days later, the patient came back to our ED for a wide left abdominal hematoma, though hemodynamically stable and eupneic. A CT-scan with contrast showed a rare and unexpected spontaneous left intercostal lung herniation complicated with a diffuse subcutaneous emphysema, pneumothorax, loculated bilateral pleural effusion and abdominal hematoma. The patient was admitted, treated conservatively and safely discharged after two weeks. We also provide a pathophysiological discussion of the case and a literature review.

Iatrogenic Colon Perforation Due to Colonoscopy Presenting as a Diffuse Subcutaneous Emphysema

Iatrogenic Colon Perforation Due to Colonoscopy Presenting as a Diffuse Subcutaneous Emphysema

Air-Driven Drill Induced Diffuse Subcutaneous Emphysema and Pneumothorax During Shoulder Arthroscopic Surgery.

Air-Driven Drill Induced Diffuse Subcutaneous Emphysema and Pneumothorax During Shoulder Arthroscopic Surgery.

Rectosigmoid perforation after high-pressure air jet exposure: A case report

Rationale: Colonic barotrauma induced by high-pressure air compressors has been reported more frequently these days due to the widespread use of air compressors in industries. Such enormous pressure into the rectum can lead to devastating injuries. Patient’s concern: A 35-year-old male was referred to our emergency department with an alleged history of directing high pressure compressed air jet towards the anus. There was diffuse subcutaneous emphysema over the neck, chest, abdomen, and extremities, and he presented with hemodynamic instability and respiratory failure. Diagnosis: Rectosigmoid perforation due to exposure to high-pressure air jet causing tension pneumoperitoneum, pneumomediastinum, pneumothorax, and extensive subcutaneous emphysema. Intervention: In view of tension pneumoperitoneum, urgent percutaneous needle decompression was performed using 16 G needle, 5 cm superomedial to the anterior superior iliac spine. The gush of air was released along with reduction in abdominal distension and improvement in hemodynamics. Outcome: The patient succumbed two days later due to septic shock. Lessons: This case highlighted the importance of promoting education about work safety among industrial workers especially in developing countries like India.

A Very Rare Complication Due to Cough in Pediatric Emergency Clinic: Spontaneous Pneumomediastinum and Diffuse Subcutaneous Emphysema

A Very Rare Complication Due to Cough in Pediatric Emergency Clinic: Spontaneous Pneumomediastinum and Diffuse Subcutaneous Emphysema

Sinus Bradycardia Following Development of Diffuse Subcutaneous Emphysema in a Child

Sinus Bradycardia Following Development of Diffuse Subcutaneous Emphysema in a Child

Tracheal Ulceration in Dettol Poisoning

Dettol a mixture of 4.8% chloroxylenol, 9% pine oil, and 12% isopropyl alcohol, is a popular household disinfectant. Serious complications of Dettol poisoning include aspiration, pneumonia, adult respiratory distress syndrome, shock, acute coronary syndrome, and cardiopulmonary arrest. We report a patient with Dettol poisoning who developed tracheal ulceration complicated by diffuse subcutaneous emphysema bilateral pneumothorax and pneumomediastinum. To the best of our knowledge, tracheal ulceration following Dettol poisoning was not reported previously.

A CASE OF MASSIVE SUBCUTANEOUS EMPHYSEMA (SE) AND PNEUMOMEDIASTINUM (PM)

SESSION TITLE: Lung Pathology 2 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Spontaneous subcutaneous emphysema and pneumomediastinum are self-limiting conditions needing only supportive therapy, but in some rare cases, surgical intervention is employed to abort respiratory or circulatory compromise. CASE PRESENTATION: A 76-year-old male with a past medical history of chronic obstructive pulmonary disease, bronchiectasis complicated by mycobacterium avium intracellulare and allergic bronchopulmonary aspergillosis (ABPA), who presented with history of persistent productive cough, acute onset left sided pleuritic chest pain with associated left neck and eye swelling. Examination of his eyes was significant for bilateral upper and lower eye lid swelling that was worst over the left lower eyelid that prevent visualization of the eyeball. There was associated enlargement of his neck that extended from his ear to his clavicles with palpable crepitus. His lung exam was notable for diffuse rales and rhonchi without associated wheezing. Contrast enhanced computed tomography (CT) scan of the neck and thorax was performed, which revealed severe diffuse subcutaneous emphysema tracking through the neck, extending into the left periorbital soft tissues, small foci of gas tracking into the left retrobulbar space, pneumomediastinum and intrathoracic air collection secondary to the rupture of a right lower lobe bleb. Patient was transferred to a thoracic center on the 4th day into his admission due to respiratory deterioration. In the setting of his progressive emphysema, dysphagia, and worsening respiratory distress a pneumatic decompressive via infraclavicular incisions were performed. He was continued on steroids, supplemental oxygen, incentive spirometry, chest physiotherapy and serial chest x-ray were performed. Patient had an overall improvement in his respiratory statue and was discharged to a rehabilitation center to continue pulmonary rehabilitation. DISCUSSION: The common presenting complaint associated with this condition includes chest pain, dyspnea, cough, neck pain, dysphagia, and dysphonia. The potential causes include blunt or penetrating chest trauma, valsalva maneuvers, coughing, inhalation of illicit drugs and strenuous activities. The pathophysiology of subcutaneous emphysema and pneumomediastinum occurs with broncho-alveolar rupture of a weakened alveolar wall secondary to chronic lung pathology, precipitated by increased intra-thoracic pressure. The main treatment modalities include bed rest, oxygen supplementation, analgesia, incentive spirometry, and pulmonary toileting. Infraclavicular incisions or placement of subcutaneous drains are the 2 most common surgical intervention used. CONCLUSIONS: SE and PM patient’s most often benefit from supportive measures such as best rest and supplemental oxygen. The benefit for surgical management has not been established but it can be offered in severe cases that have been refractory to conservative therapy. Reference #1: Kiefer MV, Feeney CM (2013) Management of Subcutaneous Emphysema with "Gills": Case Report and Review of the Literature. J Emerg Med 5: 666-669 Reference #2: Aghajanzadeh M, Dehnadi A, Ebrahimi H, Fallah Karkan M, Khajeh Jahromi S, et al. (2015) Classification And Management Of Subcutaneous Emphysema: A 10-Year Experience. Indian J Surg 77: 673-677 Reference #3: Kim K.S., Jeon H.W., Moon Y., Kim Y.D., Ahn M.I., Park J.K. Clinical experience of spontaneous pneumomediastinum: diagnosis and treatment. J. Thorac. Dis. 2015;7:1817–1824 DISCLOSURES: No relevant relationships by Olayiwola Amoran, source=Web Response No relevant relationships by Omar Ayah, source=Web Response No relevant relationships by Biren Desai, source=Web Response No relevant relationships by Zainab Mahmoud, source=Web Response

Cough Induced Pneumomediastinum due to Tracheal Tear

Spontaneous pneumomediastinum associated with subcutaneous emphysema following a sudden bout of cough is rare. Most of such pneumomediastinum would be associated with pneumothorax and would be a result of the ruptured pulmonary alveolus. Here, authors report a case of a 20-year-old male who developed swelling of neck and chest tightness following a sudden bout of cough. On examination, he was haemodynamically stable but had diffuse subcutaneous emphysema involving the neck and the upper chest. Radiology revealed pneumomediastinum without any pneumothorax. Authors think that the tracheal tear is the probable site of air leak into the soft tissue of the neck and the mediastinum. The patient was managed conservatively by close monitoring and supportive care. In patients with no prior underlying chest disease, and in those with no progressive respiratory distress, conservative treatment with cautious observation can successfully resolve this condition. This is a unique report, which attributes spontaneous pneumomediastinum without pneumothorax to the breach in the trachea.