Subcutaneous emphysema is not an uncommon condition and occurs following a chest injury or surgical procedures. Spontaneous subcutaneous emphysema SSE is a rare entity, it usually present when broncho-alveolar walls are weakened by chronic lung pathology and precipitated by chronic cough. Most widely accepted mechanism is rupture of broncho-alveolar walls with escape of air into the subcutaneous plane. Usually, it will be associated with pneumothorax or pneumomediastinum.
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Subcutaneous emphysema also known commonly, although less correctly, as surgical emphysema , strictly speaking, refers to gas in the subcutaneous tissues.
But the term is generally used to describe any soft tissue emphysema of the body wall or limbs since the gas often dissects into the deeper soft tissues and musculature along fascial planes. Clinically it is felt as crepitus and, if extensive, may cause soft tissue swelling and discomfort.
Even when severe, subcutaneous emphysema is typically benign, although complications such as airway compromise, respiratory failure, pacemaker malfunction and tension phenomena have been described. In the trauma situation, the gas often does not need treatment itself, but its importance lies in the fact that its presence indicates possible serious injuries that do require urgent management.
Gas can track along fascial planes and enter the head, neck, limbs, chest, abdomen, and scrotum. There are often striated lucencies in the soft tissues that may outline muscle fibers.
Often there are displaced rib fractures indicating a cause of the gas. Subcutaneous emphysema is readily visible on CT scans, with pockets of gas seen as extremely dark low air attenuation areas in the subcutaneous space. The scattering from the inhomogenous collections will often result in reverberation and comet tail artifacts. Subcutaneous emphysema is particularly disruptive to lung ultrasonography , as it may obscure both normal structures and mimic other pathology 7 ;.
Treatment is directed at the underlying cause, while the subcutaneous gas is absorbed by the body over time. Symptomatic management should also be provided. However, in rare instances where the subcutaneous gas is compromising overlying soft tissue or causing a compartment syndrome management may involve the release of the gas by the surgical division of the soft tissues or percutaneous drain insertion.
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Subcutaneous emphysema SE is a condition often causing minimal symptoms, but sometimes it can be severe and even life-threatening. This study is the first great survey about SE. The aim of this study is to classify and evaluate the etiology, signs, symptoms, and management of SE. This retrospective study was performed by reviewing patients who had been diagnosed as having SE in Rasht, between January and January We classified the severity of SE in five grades including the 1 base of the neck, 2 all of the neck area, 3 subpectoralis major area, 4 chest wall and all of the neck area, and 5 chest wall, neck, orbit, scalp, abdominal wall, upper limbs, and scrotum.
Classification and Management of Subcutaneous Emphysema: a 10-Year Experience
Subcutaneous refers to the tissue beneath the skin , and emphysema refers to trapped air. Since the air generally comes from the chest cavity , subcutaneous emphysema usually occurs on the chest, neck and face, where it is able to travel from the chest cavity along the fascia. Numerous etiologies of subcutaneous emphysema have been described. Pneumomediastinum was first recognized as a medical entity by Laennec , who reported it as a consequence of trauma in Louis Hamman described it in postpartum woman; indeed, subcutaneous emphysema is sometimes known as Hamman's syndrome. However, in some medical circles, it can instead be more commonly known as Macklin's Syndrome after L. Macklin, in , and M.