Massive Traumatic Subcutaneous Emphysema

Abstract

74 year-old-man, former smoker, with chronic obstructive pulmonary disease GOLD grade 4, group D, with emphysema component, treated in a pulmonary rehabilitation program, on oxygen therapy and nocturnal bi-level positive airway pressure (BiPAP) ventilation. During the night he had a traumatic rib fracture (5–11th right ribs) but still he used BiPAP ventilation during the sleep. In the morning after he presented with a diffuse and massive emphysema in the face, thorax and abdominal regions. On physical examination, the patient presented with massive swelling and crepitus on palpation. A chest computed tomography (CT) scan confirmed a diffuse subcutaneous emphysema and revealed a mediastinal emphysema and bilateral small pneumothorax. A fast resolution of the emphysema was of paramount importance as the patient was severely agitated due to his inability to open both eyes, and the need to reintroduce BiPAP ventilation as soon as possible. It was placed a fenestrated subcutaneous catheter on left hemithorax and a subcutaneous ostomy on right hemithorax for comparative purpose. It was also performed a confluent centripetal massage towards drainage orifices, with immediate and substantial improvement of emphysema, especially in left hemithorax, and progressive ocular opening. Further emphysema absorption occurred during hospitalization.

Pneumoscrotum with extensive subcutaneous emphysema in traumatic perineal injury: A case report

“…While chest tubes and laparotomy and debridement of wound and antibiotic is as per the pathology. Table 1 summarizes the reported cases of traumatic pneumoscrotum diagnosed with CT scan 10–22 …”

“…Table 1 summarizes the reported cases of traumatic pneumoscrotum diagnosed with CT scan. [10][11][12][13][14][15][16][17][18][19][20][21][22]…”

Spontaneous Pneumomediastinum Revealing Asthma: The Macklin Effect

“…The case described here shows the alveolar rupture with air dissection along the interstitial sheaths toward the mediastinum, eventually leading to a pneumomediastinum. Alveolar rupture is responsible for more than 95% of cases of pneumomediastinum and is more frequent than esophageal or tracheobronchial disruptions [ 5 ]. It is called the Macklin effect and it is identified on chest CT scan by visualizing air dissection along perivascular and peribronchial sheaths, but CT scan confirmation is unnecessary [ 6 ].…”