Subcutaneous emphysema: symptoms, causes, diagnosis.

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Subcutaneous emphysema is a condition in which air is trapped under the skin. Emphysema simply means "air" and "subcutaneous" means the location of the air.

This type of emphysema is different from other types of emphysema that you have heard of, which are lung conditions and are not caused by smoking. This can happen after medical procedures, surgeries, accidents, injuries, or infections.

Subcutaneous emphysema most often occurs on the chest, neck, and face because these areas of the body are so close to the lungs, but it can occur in all parts of the body for a variety of reasons. It is more common in men than women.

Subcutaneous emphysema of the right breast. Sopone Navut / Getty Images Plus

Symptoms

When it comes to subcutaneous emphysema, there is a wide range of severity. In mild cases, you may not experience any symptoms, while more severe cases can lead to significant discomfort and serious complications.

The symptoms of subcutaneous emphysema also differ depending on the underlying cause and its location in the body. Most people with subcutaneous emphysema are likely to experience:

  • Swelling (swelling) in the affected area.
  • Cracking on palpation of the area (examined by touch)

A distinctive crunch may be emitted when touching the surface of the skin. This is called crepitus, and it can help healthcare providers first suspect and then diagnose. This is why subcutaneous emphysema is sometimes called crepitus or crepitus of the chest.

Other symptoms, depending on individual circumstances, may include:

  • Throat pain
  • Pain in the neck
  • Difficulty breathing
  • Difficulty swallowing or speaking / voice change
  • Swelling or swelling

Severe cases of subcutaneous emphysema can lead to airway involvement, pacemaker failure, respiratory failure, cardiovascular failure, or tension pneumothorax.

Other serious complications can include tracheal compression, skin necrosis (death of body tissue), compartment syndrome, and even poor brain perfusion.

Causes

There are three layers of skin. The outermost layer is called the epidermis; below is the dermis, and then the subcutaneous layer , which consists mainly of adipose and connective tissue.

It is in this layer, the subcutaneous layer, where air is trapped in cases of subcutaneous emphysema, although this may indicate that air is also found in deeper layers of tissue.

There are many underlying causes of subcutaneous emphysema, including, but not limited to:

  • Injuries to almost any part of the body, but especially to the chest, sinuses, or facial bones.
  • Pneumothorax
  • Necrotic bacteria infection ( gangrene )
  • Surgical trauma
  • Laparoscopic surgeries (these are risky because the abdomen is often full of carbon dioxide)
  • Barotrauma that occurs during diving or other activity that exposes a person to sudden changes in altitude.
  • Accidental injury to the trachea during intubation (insertion of the breathing tube)
  • Fan failures or problems
  • Injury to the esophagus (often during feeding tube insertion)
  • Bowel or esophageal perforation
  • Mask ventilation during CPR

In rare cases, subcutaneous emphysema can occur in the absence of a known cause. This is called spontaneous subcutaneous emphysema.

Diagnostics

If your symptoms, especially crepitus, and a medical history make your doctor suspect subcutaneous emphysema, he may order some of the following tests to help diagnose:

  • X-rays may be positive for a sign of a ginkgo leaf (streak of gas along the pectoralis major muscle).
  • Computed tomography (CT) scans can show dark air pockets in the subcutaneous layer and can also be helpful in identifying the source of the air.
  • Laryngoscopy and / or bronchoscopy may be performed if subcutaneous emphysema is suspected to be the result of intubation trauma.
  • Ultrasound

Edema caused by subcutaneous emphysema is mistaken for other conditions, such as allergic reactions, but the presence of crepitus and the absence of lip swelling in subcutaneous emphysema can help healthcare providers differentiate between these conditions.

Watch out

Subcutaneous emphysema usually resolves in about 10 days without serious complications if the underlying cause is successfully treated. The air is gradually reabsorbed. Therefore, it is important to determine how the disease originated and begin treatment.

It is also important to monitor symptoms and any discomfort. In minor cases of subcutaneous emphysema, you may not feel discomfort. More severe cases of subcutaneous emphysema can cause unpleasant symptoms. If you feel uncomfortable, this can be controlled with oxygen, abdominal braces, or pain relievers, depending on your individual circumstances.

The administration of highly concentrated oxygen is often used as a treatment because it helps the body absorb subcutaneous air more quickly.

Severe cases of subcutaneous emphysema may require surgery or drainage. Another common treatment is to make two subclavian incisions on each side (these are deep incisions under the clavicular bone). Sometimes it is also necessary to insert a drainage tube to remove the air. In some cases, small incisions can be made in other parts of the body, or needles or catheters can be used to remove excess air.

Forecast

Despite the potentially fatal complications that can occur from subcutaneous emphysema, they are actually quite rare and the prognosis is good. Most cases do not require treatment, but they will resolve on their own. One study found that, across all severity levels, the median hospital stay of patients with subcutaneous emphysema was 16 days.

Front facing

Mild cases of subcutaneous emphysema may not be worrisome, but in other cases, facial swelling or tissue necrosis can sometimes cause changes in your appearance that can be worrisome. It is important to remember that these appearance changes will improve or disappear over time.

Depending on the underlying cause of your subcutaneous emphysema, you may be able to deal with other health problems that may also be of concern. Ask not only your family and friends, but also your health care team, to help you cope with the emotional aspects of your illness. Your healthcare team will be able to connect you with a support group or other resources that can help you recover and recover.

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