Subcutaneous emphysema is an indication that
Show Citation, DOI & article dataCitation: D'Souza D, Rock P, Lavares D, et al. Subcutaneous emphysema. Reference article, Radiopaedia.org (Accessed on 16 Nov 2022) https://doi.org/10.53347/rID-4038 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. On this page: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. Causes of subcutaneous emphysema can be divided into:
Trauma is the most common cause seen 5. Progression of subcutaneous emphysema following thoracic surgery should raise the suspicion for a possible bronchial leak 10. Plain radiographThere are often striated lucencies in the soft tissues that may outline muscle fibers. If affecting the anterior chest wall, subcutaneous emphysema can outline the pectoralis major muscle, giving rise to the ginkgo leaf sign 2. Often there are displaced rib fractures indicating a cause of the gas. CTSubcutaneous emphysema is readily visible on CT scans, with pockets of gas seen as extremely dark low (air) attenuation areas in the subcutaneous space. UltrasoundThe mismatch in acoustic impedance between subcutaneous gas collections and surrounding soft tissue results in near-complete reflection of incident ultrasound waves, obscuring tissues in the far-field from the ("dirty") acoustic shadows cast by the hyperechoic, punctiform collections of gas. The scattering from the inhomogeneous 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 and prognosisTreatment 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.
Promoted articles (advertising)Recommended textbook solutions
Pharmacology and the Nursing Process7th EditionJulie S Snyder, Linda Lilley, Shelly Collins 388 solutions
Clinical Reasoning Cases in Nursing7th EditionJulie S Snyder, Mariann M Harding 2,512 solutions
Medical Terminology for Health Professions8th EditionAnn Ehrlich, Carol L Schroeder, Katrina A Schroeder, Laura Ehrlich 1,792 solutions
Medical Language for Modern Health Care4th EditionDavid M Allan, Rachel Basco 2,732 solutions What does subcutaneous emphysema indicate?Subcutaneous emphysema occurs when air gets into tissues under the skin. This most often occurs in the skin covering the chest or neck, but can also occur in other parts of the body.
What is the most likely cause of subcutaneous emphysema?Subcutaneous emphysema can result from surgical, traumatic, infectious, or spontaneous etiologies. Injury to the thoracic cavity, sinus cavities, facial bones, barotrauma, bowel perforation, or pulmonary blebs are some common causes.
Is subcutaneous emphysema serious?Subcutaneous emphysema (SE) is a condition often causing minimal symptoms, but sometimes it can be severe and even life-threatening.
What is the treatment subcutaneous emphysema?Several methods have been described in the literature for the treatment of extensive subcutaneous emphysema, including: emergency tracheostomy, multisite subcutaneous drainage, infraclavicular “blow holes” incisions and subcutaneous drains or simply increasing suction on an in situ chest drain.
|