Iatrogenic Pneumothorax with Subsequent Subcutaneous Emphysema

Abstract

This presentation reports a case of a 67-year-old former smoker who presented to the emergency department with new-onset hemoptysis. During the workup, a left lung mass was identified. During the biopsy, he experienced a pneumothorax. The procedure had to be aborted, and a small-sized chest tube was placed. The following day, the patient underwent a successful second lung biopsy, but a day later he developed significant subcutaneous emphysema despite having a chest tube. The same day, the smaller chest tube was removed and a larger chest tube was inserted. While small chest tubes are preferred for patient comfort, in some patients with risk factors, a large chest tube is recommended. Over the course of a few days, the emphysema improved.

Massive Subcutaneous Emphysema and Pneumo-Mediastinum after Percutaneous Lung Biopsy

“…Very few number of case reports of severe SE have been reported in the literature. 4,5 Free air in the subcutaneous thoracic region can be caused due to parietal pleural injury that further diffuses in myofascial planes dissecting them to cause severe subcutaneous emphysema, as discussed in our case. There is a significant correlation between the underlying lung parenchymal condition, which in our case study showed emphysematous changes and the increase in the risk of pneumothorax, and further in subcutaneous emphysema.…”

“…2 Patient position, small size of the lesion, multiple pleural punctures, and distance of the lesion from the pleura increases the risk of pneumothorax proportionally. 1 3 4…”

“…2 Patient position, small size of the lesion, multiple pleural punctures, and distance of the lesion from the pleura increases the risk of pneumothorax proportionally. 1,3,4 Subcutaneous emphysema (SE) is the leakage of air from the respiratory or gastrointestinal system that diffuses under the skin and myofascial planes. 5 It is found more commonly in association with pneumothorax 6 and is often accompanied by pneumomediastinum.…”

Extensive Subcutaneous Emphysema Associated With Pneumothorax, Pneumomediastinum, and Pneumoperitoneum: A Case Report

“…Furthermore, this method is thought to provide a rapid and cosmetically appealing outcome compared with more invasive alternatives such as cervical mediastinotomy [ 5 ]. Our management largely focused on the right pneumothorax evacuation [ 12 ]. The patient’s SE continued to improve throughout her hospital stay, and she did not require blow holes or infraclavicular incisions.…”