Soft Tissue Emphysema Research Articles

A teenager with abdominal pain and soft-tissue emphysema

A 15-year-old girl presented with a sudden onset of abdominal and chest pain, nausea and postprandial gastric fullness. She had a history of an eating disorder with low weight and amenorrhea of 6 months' duration. On physical examination, her weight, height and body mass index were 160.5 cm, 37.0 kg

Die Perforation des Hypopharynx als seltene, lebensbedrohliche Komplikation der endotrachealen Intubation

Endotracheal intubation is regarded as the gold standard technique to secure the airway with a low complication rate, however, perforating tracheal or esophageal injuries are rare but severe complications. Two cases of hypopharyngeal perforation after intubation are presented and discussed. While intubation of the first patient was anticipated to be difficult, the second patient did not present any risk factors. One patient developed a typical clinical pattern of difficult swallowing, soft tissue emphysema of the neck, pyrexia, and leukocytosis. The other initially showed minor symptoms but increasing difficulties in swallowing led to the diagnosis of a retropharyngeal abscess. A subsequent acute airway obstruction required emergency invasive airway access. In both cases surgical intervention in combination with antibiotic therapy resulted in complete healing. Physicians performing endotracheal intubation or dealing with patients after intubation, should be aware of the clinical symptoms because only early diagnosis and therapy can prevent development of mediastinitis. In "cannot intubate-cannot ventilate" situations, wide bore transtracheal airway access under local anaesthesia and spontaneous breathing should have priority and temporary tracheotomy should also be considered. To prevent hypopharyngeal injury a thorough evaluation of the "difficult airway" and the atraumatic performance of direct laryngoscopy and endotracheal intubation are mandatory.

Soft Tissue Cervicofacial Emphysema After Dental Treatment

The development of soft tissue cervicofacial emphysema after dental treatment is a rare complication, with few descriptions in the dermatologic literature. It is usually restricted to only moderate local swelling. However, spread of larger amounts of air into deeper spaces may sometimes cause serious complications, including airway compromise due to accumulation of air in the retropharyngeal space, pneumomediastinum, and pneumopericardium. Fatal air embolism and soft tissue infections through dissemination of oral flora microorganisms along the emphysematous tracts have also been described. Therefore, early recognition is important, but the unfamiliarity of dermatologists with this condition often causes diagnostic problems. Important differential diagnoses include angioedema, soft tissue infections, and hematoma. We describe 2 patients with different severity of the emphysema and airway compromise, representing the wide spectrum of its clinical expression. Our first case was remarkable, because the emphysema was massive and extended far into deep spaces, including the orbita, mediastinum, and pleural cavity. The present case is only the third report of pneumothorax associated with dental treatment published to date. The patient's condition was initially misdiagnosed and treated as angioedema. Dermatologists should be aware that soft tissue emphysema can cause acute swelling of the cervicofacial region after dental procedures. Angioedema is an important differential diagnosis, because it may be caused by the use of nonsteroidal anti-inflammatory drugs or local anesthetics, which are often administered during dental treatments.

Advanced anorexia nervosa, associated with pneumomediastinum, pneumothorax, and soft‐tissue emphysema without Esophageal lesion

We describe the case of a 20-year-old female patient suffering from anorexia nervosa since the age 15 of years. When admitted, she was 168 cm tall with a weight of 35 kg (body mass index [BMI] = 12.4). A week after admission, the patient complained of retrosternal pain, and a few hours later she developed extensive soft-tissue emphysema. The X-ray picture of her thorax showed left-hand supraclavicular and infraclavicular emphysema, extensive emphysema in both sides of the soft tissue of the throat, a left-hand apical pneumothorax (4 mm), and a pneumomediastinum. We discuss the extent to which these symptoms are interrelated in the sense of a causal nexus. We ruled out any other differential-diagnostic etiopathogenic factors and concluded that the cause of our patient's soft-tissue emphysema, pneumothorax, and pneumomediastinum might well be autodestructive behavior.

Percutaneous Transtracheal Jet Ventilation in Head and Neck Surgery

To assess the safety and efficacy of percutaneous transtracheal jet ventilation (PTJV) in the management of the difficult airway. Retrospective case series. Academic, tertiary care medical center. Forty-three consecutive PTJV procedures performed on 33 patients with anticipated airway difficulty undergoing direct laryngoscopy for diagnosis and/or treatment of head and neck cancer (91%) or benign lesions. Duration of PTJV, oxygen saturation values by pulse oximetry, and incidence of tracheotomy and complications. The mean duration of PTJV was 43 minutes, and mean minimum oxygen saturation was 97%. Biopsy was performed in 27 (62%) of the cases, and a laser excision in 12 (28%). Seven tracheotomies were planned preoperatively, and 2 were performed intraoperatively. Two additional patients required tracheotomies in the immediate postoperative period. Two (5%) complications occurred: 1 pneumothorax that resolved with chest tube insertion and 1 kinked catheter resulting in soft tissue emphysema that resolved spontaneously. Percutaneous transtracheal jet ventilation is a safe and effective method of ventilation in patients with anticipated airway difficulty. It is particularly useful in patients who are not in immediate airway distress preoperatively but who may be difficult or impossible to intubate after induction of general anesthesia. Percutaneous transtracheal jet ventilation may help to avoid tracheotomy in this setting and should be routinely available as an option for airway management in patients with head and neck cancer.

Diffuse soft tissue emphysema in anorexia nervosa: A case report

Anorexia nervosa (AN) is an eating disorder that occurs mainly among young females and its prevalence has increased in recent decades. We reported a patient with AN with spontaneous diffuse soft tissue emphysema and bicytopenia, both of which are very rare complications of AN. Our patient, a 20-year-old woman, had lost 41.6% of her previous body weight within 9 months. Her body mass index was 10.8 and amenorrhea had persisted for 5 months. After admission, she was diagnosed with AN-restrictive subtype. She was noted to have crunching sounds in the neck and upper chest wall during hospitalization. A chest X-ray and chest computed tomography scan both revealed diffuse soft tissue emphysema including subcutaneous emphysema, pneumomediastinum, and pneumoretroperitoneum. Diffuse soft tissue emphysema improved gradually and completely resolved on the 21st day of hospitalization. This condition seems to be benign and only a short period of hospitalization is required.

Pneumomediastinum and soft tissue emphysema of the neck in postmortem CT and MRI; a new vital sign in hanging?

Spontaneous pneumomediastinum commonly occurs in healthy young men or parturient women in whom an increased intra-alveolar pressure (Valsalva maneuver, asthma, cough, emesis) leads to the rupture of the marginal pulmonary alveoli. The air ascends along the bronchi to the mediastinum and the subcutaneous space of the neck, causing cervico-fascial subcutaneous emphysema in 70–90% of cases. Ninety-five forensic cases, including five cases of hanging, were examined using postmortem multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI) prior to autopsy until December 2003. This paper describes the findings of pneumomediastinum and cervical emphysema in three of five cases of hanging. The mechanism of its formation is discussed based on these results and a review of the literature. In conclusion, when putrefaction gas can be excluded the findings of pneumomediastinum and cervical soft tissue emphysema serve as evidence of vitality of a hanged person. Postmortem cross-sectional imaging is considered a useful visualization tool for emphysema, with a great potential for examination and documentation.

Lesões traumáticas do tórax. Aspectos na tomografia computadorizada

Trauma is nowadays one of the most common causes of death and traumatic thoracic lesions are important agravant to trauma patients. In this work the aspects of computed tomography from 200 cases of thoracic trauma were studied. Lung lesions predominated, found in 192 cases (96%), manifested as contusions in 178 cases (89%), atelectasis in 41 cases (20.5%), lacerations in 15 cases (7.5%) and hematomas in 6 cases (3%). Pleural lesions were showed in 140 cases (70%), among them in 121 cases (60.5%) there were hemothorax and in 84 cases (42%), pneumothorax. Mediastinal lesions were observed in 28 cases (14%), with pneumomediastinum in 18 cases (9%), mediastinal hematoma in 7 cases (3.5%), hemopericardium in 4 cases (2%) and aortic lesions in 3 cases (1.5%). Diaphragmatic rupture was seen in 8 patients (4%). Soft tissue emphysema was demonstrated in 36 cases (18%).

Chest Pain–Swimming

2032 HISTORY: A 15-year-old competitive swimmer presented to Mayo Clinic with a 24-hour history of sub-sternal chest pain with deep inspiration, associated with anterior neck pain. Onset was during the previous day's training session. The patient was swimming underwater three consecutive 25-meter pool lengths, emerging to take very short breaths, then resuming the described swimming exercise. He developed chest discomfort sub-sternally, and soon thereafter developed neck discomfort. He described this as fullness, as well as a sharp pain in the tracheal region. He had pain with flexion and rotation of the neck. With deep inspiration, he would have a dull sub-sternal ache. Within several hours, his voice changed to a higher pitch. Associated symptoms included mild anxiousness, but he denied shortness of breath. No prior episodes. PHYSICAL EXAM: Examination of the neck revealed pain anteriorly with rotation, flexion and extension. Palpation revealed crepitus in the thyroid region tracking along the trachea. Examination of the heart revealed regular rate and rhythm. No gallops, rubs or murmurs. Examination of the chest revealed no subcutaneous emphysema. Lungs were clear to auscultation bilaterally. However, at the posterior apices, there was a faint popping sound, which cleared. No wheezes were noted. DIFFERENTIAL DIAGNOSIS: Pneumomediastinum Pneumothorax Pneumopericardium Upper respiratory infection Reactive airway/allergic reaction Cervical injury Myocardial infarction/cardiac disease Gastroesophageal Reflux Disease Esophageal Spasm TEST AND RESULTS: Chest x-ray: spontaneous pneumomediastinum with subcutaneous emphysema of the soft tissues in the neck. No pneumothorax or acute changes in the lung fields. Heart size was normal. Neck x-rays: showed deep cervical soft tissue emphysema. Chest CT scan four days after initial chest x-ray: remarkable only for very subtle evidence of residual free air. FINAL/WORKING DIAGNOSIS: Spontaneous pneumomediastinum, with secondary anterior neck subcutaneous emphysema, from extreme breath-holding technique. TREATMENT AND OUTCOMES: Refrain from athletic activities until symptoms of chest discomfort resolve. Repeat chest x-rays must appear normal prior to resumption of swimming. Chest x-ray sequence on day one and day five revealed Saturday pneumomediastinum rapidly resolving. Parallel clinical course. Patient returned successfully to competitive swimming in ten days. Instructed to refrain from utilization of above breathing maneuver. No known recurrence to date.

Chest Pain???Swimming

2032 HISTORY: A 15-year-old competitive swimmer presented to Mayo Clinic with a 24-hour history of sub-sternal chest pain with deep inspiration, associated with anterior neck pain. Onset was during the previous day's training session. The patient was swimming underwater three consecutive 25-meter pool lengths, emerging to take very short breaths, then resuming the described swimming exercise. He developed chest discomfort sub-sternally, and soon thereafter developed neck discomfort. He described this as fullness, as well as a sharp pain in the tracheal region. He had pain with flexion and rotation of the neck. With deep inspiration, he would have a dull sub-sternal ache. Within several hours, his voice changed to a higher pitch. Associated symptoms included mild anxiousness, but he denied shortness of breath. No prior episodes. PHYSICAL EXAM: Examination of the neck revealed pain anteriorly with rotation, flexion and extension. Palpation revealed crepitus in the thyroid region tracking along the trachea. Examination of the heart revealed regular rate and rhythm. No gallops, rubs or murmurs. Examination of the chest revealed no subcutaneous emphysema. Lungs were clear to auscultation bilaterally. However, at the posterior apices, there was a faint popping sound, which cleared. No wheezes were noted. DIFFERENTIAL DIAGNOSIS: Pneumomediastinum Pneumothorax Pneumopericardium Upper respiratory infection Reactive airway/allergic reaction Cervical injury Myocardial infarction/cardiac disease Gastroesophageal Reflux Disease Esophageal Spasm TEST AND RESULTS: Chest x-ray: spontaneous pneumomediastinum with subcutaneous emphysema of the soft tissues in the neck. No pneumothorax or acute changes in the lung fields. Heart size was normal. Neck x-rays: showed deep cervical soft tissue emphysema. Chest CT scan four days after initial chest x-ray: remarkable only for very subtle evidence of residual free air. FINAL/WORKING DIAGNOSIS: Spontaneous pneumomediastinum, with secondary anterior neck subcutaneous emphysema, from extreme breath-holding technique. TREATMENT AND OUTCOMES: Refrain from athletic activities until symptoms of chest discomfort resolve. Repeat chest x-rays must appear normal prior to resumption of swimming. Chest x-ray sequence on day one and day five revealed Saturday pneumomediastinum rapidly resolving. Parallel clinical course. Patient returned successfully to competitive swimming in ten days. Instructed to refrain from utilization of above breathing maneuver. No known recurrence to date.

Extensive intraosseous gas associated with lymphangiomatosis of bone: report of three cases.

Asymptomatic pneumatosis may be found in patients with lymphangiomatosis of bone. The authors report three cases from three institutions in which development of intraosseous gas in association with lymphangiomatosis of bone was found incidentally at imaging. Soft-tissue emphysema also developed in two cases. In all three cases, intraosseous gas developed after biopsy or surgery in the areas involved with lymphangiomatosis.

Anorexia nervosa with soft-tissue emphysema in multiple locations.

Anorexia nervosa with soft-tissue emphysema in multiple locations.K Satoh, M Ohkawa, M Tanabe and H SuwakiAudio Available | Share

What to Look for in Rib Fractures and How

A MAN was involved in a fight during hospitalization in a state hospital. A chest roentgenogram was obtained, which showed a rib fracture and other features (Fig 1). What are the other features? Answer: emphysema of the chest wall; pneumothorax, left; pneumomediastinum. The multiple lines of translucency noted in the left hemithorax were caused by air between the muscle fibers in the chest wall and not by pulmonary vascular markings. No vascular marking is recognized in the left hemithorax. Air is observed in the pleural cavity medial to the collapsed lung. A chest film obtained earlier the same day showed the pneumothorax and the collapsed lung. Comment When soft-tissue emphysema is detected after traumatic injury to a rib, it should be assumed that the lung has been injured, and signs of pneumothorax should be sought. These are (1) demonstration of the lung margin, (2) the absence of lung markings peripheral

Soft tissue emphysema

Soft tissue emphysema

Soft tissue emphysema

Many cases of soft tissue emphysema have been reported; it is recognized as a common surgical and dental complication. This report adds to the number of recorded cases and emphasizes the potential for emphysema with the use of high pressure dental instruments. It also shows that the point of entry of air may be overlooked and will therefore delay diagnosis. Proper diagnosis and recognition of the potential for widespread secondary infection dictate the management of emphysema. If any doubt should exist, consultation should be obtained without hesitation.

The radiology of perforated oesophagus

The nature of the plain film changes resulting from perforation of the oesophagus depend upon the site of perforation, the integrity or otherwise of the mediastinal parietal pleura, and the time interval between perforation and radiological investigation. Initial radiographs taken within minutes of perforation may be normal, and soft tissue emphysema, mediastinal widening and abscess formation may not be detected for up to 24 hours. Cervical oesophageal perforation produces cervical emphysema early, but mediastinal abnormalities are rare if the condition is treated promptly. Intrathoracic perforation promotes early mediastinal changes such as emphysema and abscess formation. If the mediastinal pleura is ruptured there is early development of hydro- or pyopneumothorax. If pleural integrity is maintained, mediastinal changes develop rapidly and a pleural effusion appears late. The site of oesophageal perforation and any interconnecting mediastinal and pleural spaces are reliably demonstrated by a water-soluble contrast medium swallow with radiographs taken with a horizontal beam , with the patient prone, supine, right and left decubitus.

Pneumomediastinum as a complication of pneumoencephalography in children.

We recently encountered pneumomediastinum and soft-tissue emphysema occurring during pneumoencephalography in 5 children. Because this complication is not described in several textbooks of neuroradiology (1, 4), these cases will be described, and possible mechanisms for the development of pneumomediastinum following pneumoencephalography discussed. Case Material Initially, air in the retropharyngeal soft tissues was observed during pneumoencephalography in 2 patients (Fig. 1), and pneumomediastinum was confirmed on radiographs of the chest. Subsequently, chest roentgenograms were obtained on all children in whom pneumoencephalography was performed. Pneumomediastinum as well as air in the retropharyngeal space was soon found in a third child. Radiographs of the lumbar spine were obtained in 2 of these 3 patients but no air was noted in soft tissues about it in either instance (Fig. 2). Following the recognition of this finding, the authors reviewed 79 consecutive pneumoencephalography studies performed over the previous four years at the University of Arkansas Medical Center. Air in the retropharyngeal soft tissues was found in 2 additional children. This finding was presumed indicative of pneumomediastinum, although radiographs of the chest were not available for confirmation. In this institution, lumbar pneumoencephalography is performed with the patient in a flexed position, either recumbent or sitting upright, with the chin and knees touching. Only minimal sedation is used. The indications for the examination were mental retardation in 3 patients, diabetes insipidus in 1, and cranial enlargement in 1. In 4 of the 5 patients in whom pneumomediastinum developed during pneumoencephalography, air was present in either the cerebral subarachnoid space or the ventricular space. In the fifth patient, air was noted in the spinal subarachnoid space when the pneumomediastinum was recognized, and the procedure was terminated. The patients in whom pneumomediastinum developed ranged in age from seven days to four years, only 1 being more than one year old. The total incidence of this pneumoencephalography complication in children under five years of age was 10 per cent. No complications developed from the pneumomediastinum in any case. Air in the soft tissues of the neck and axillae was noted twenty-four hours after the pneumoencephalogram in 2 patients, but this cleared spontaneously. Discussion The most immediately obvious explanation for a pneumomediastinum following pneumoencephalography is that the air injected reached the mediastinum by some devious route. A fascial space does exist by which air could pass from the region of the lumbar spine to the mediastinum (2). It extends from the base of the skull to the tip of the coccyx and is bounded anteriorly by the prevertebral fascia and posteriorly by the anterior surfaces of the vertebral bodies. Laterally this space extends to the tips of the transverse processes.