Classification and Management of Subcutaneous Emphysema: a 10-Year Experience

Aghajanzadeh, Manouchehr; Dehnadi, Anosh; Ebrahimi, Hannan; Karkan, Morteza Fallah; Jahromi, Sina Khajeh; Maafi, Alireza Amir; Aghajanzadeh, Gilda

doi:10.1007/s12262-013-0975-4

Cited by 92 publications

(150 citation statements)

References 14 publications

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“…We defined pneumothorax and subcutaneous emphysema as air leak-related complications after chest drainage tube removal. Both are delayed presentations of a small amount of air leakage after chest drainage tube removal [18,19]. Although these may be subclinical in most cases, reinsertion of chest tubes may be needed once there is a certain amount of air leakage that the drainage system is unable to detect before tube removal.…”

Section: Discussionmentioning

confidence: 99%

Complications after Chest Tube Removal and Reinterventions in Patients with Digital Drainage Systems

Lee

Hsu

Huang

et al. 2019

JCM

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Introduction: Digital thoracic drainage systems are a new technology in minimally invasive thoracic surgery. However, the criteria for chest tube removal in digital thoracic drainage systems have never been evaluated. We aim to investigate the incidence and predictive factors of complications and reinterventions after drainage tube removal in patients with a digital drainage system. Method: Patients who received lung resection surgery and had their chest drainage tubes connected with a digital drainage system were retrospectively reviewed. Results: A total of 497 patients were monitored with digital drainage systems after lung resection surgery. A total of 175 (35.2%) patients had air leak-related complications after drainage tube removals, whereas 25 patients (5.0%) required reintervention. We identified that chest drainage duration of five days was an optimal cut-off value in predicting air leak-related complications and reinterventions. In multiple logistic regression analysis, previous chest surgery history; small size (16 Fr.) drainage tubes; the presence of initial air leaks, defined as air leaks recorded by the digital drainage system immediately after operation; and duration of chest drainage ≥5 days were independent factors of air leak-related complications, whereas the presence of initial air leaks and duration of chest drainage ≥5 days were independent predictive factors of reintervention after drainage tube removal. Conclusion: Air leak-related complications and reinterventions after drainage tube removals happened in 35.2% and 5.0% of patients with digital thoracic drainage systems. The management of chest drainage tubes in patients with predictive factors, i.e., the presence of initial air leaks and duration of chest drainage of more than five days, should be treated with caution.

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Section: Discussionmentioning

confidence: 99%

Complications after Chest Tube Removal and Reinterventions in Patients with Digital Drainage Systems

Lee

Hsu

Huang

et al. 2019

JCM

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“…1) [5]. The most common clinical symptom of subcutaneous emphysema is swelling around the neck accompanied by pain in the chest [35]. Crepitus can be typically felt by physical examinations.…”

Section: Abnormal Air Collection In the Chest Wallmentioning

confidence: 99%

“…or from gas-forming microbes (necrotizing fasciitis, Fournier gangrene, etc.) [5,35]. Subcutaneous emphysema often causes minimal symptoms, is not critical, and does not require a specific treatment [35].…”

Section: Abnormal Air Collection In the Chest Wallmentioning

confidence: 99%

Thoracic abnormal air collections in patients in the intensive care unit: radiograph findings correlated with CT

et al. 2020

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An abnormal collection of air in the thorax is one of the most common life-threatening events that occurs in the intensive care unit. Patient management differs depending on the location of the air collection; therefore, detecting abnormal air collection and identifying its exact location on supine chest radiographs is essential for early treatment and positive patient outcomes. Thoracic abnormal air collects in multiple thoracic spaces, including the pleural cavity, chest wall, mediastinum, pericardium, and lung. Pneumothorax in the supine position shows different radiographic findings depending on the location. Many conditions, such as skin folds, interlobar fissure, bullae in the apices, and air collection in the intrathoracic extrapleural space, mimic pneumothorax on radiographs. Additionally, pneumopericardium may resemble pneumomediastinum and needs to be differentiated. Further, some conditions such as inferior pulmonary ligament air collection versus a pneumatocele or pneumothorax in the posteromedial space require a differential diagnosis based on radiographs. Computed tomography (CT) is required to localize the air and delineate potential etiologies when a diagnosis by radiography is difficult. The purposes of this article are to review the anatomy of the potential spaces in the chest where abnormal air can collect, explain characteristic radiographic findings of the abnormal air collection in supine patients with illustrations and correlated CT images, and describe the distinguishing features of conditions that require a differential diagnosis. Since management differs based on the location of the air collection, radiologists should try to accurately detect and identify the location of air collection on supine radiographs.

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“…2 It is most commonly found in the soft tissues of the chest wall and neck and can be diagnosed on examination and by radiological imaging. 1,3 It presents as a swelling and crepitation on palpation, which is often compared to the feeling of 'bubble wrap under the skin'. It is usually a self-limiting condition but can be severe or even life threatening if extensive due to restriction of thoracic expansion by a large volume of air in the subcutaneous tissue.…”

Section: What Lies Beneathmentioning

confidence: 99%