• COVID-19
• SARS-CoV-2 pneumonia
• case report
• mediastinal drain
• pneumomediastinum

• catheter
• chest tube
• subcutaneous cannula
• subcutaneous emphysema
• therapy

• Intensive care
• Minimally invasive cardiac surgery
• Postoperative care
• Robotic cardiac surgery
• Subcutaneous emphysema

• Humans
• Robotic Surgical Procedures/methods
• Robotic Surgical Procedures/adverse effects
• Subcutaneous Emphysema/etiology
• Subcutaneous Emphysema/epidemiology
• Risk Factors
• Male
• Female
• Aged
• Middle Aged
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Treatment Outcome
• Coronary Artery Bypass/adverse effects
• Coronary Artery Bypass/methods
• Cardiac Surgical Procedures/methods
• Cardiac Surgical Procedures/adverse effects
• Incidence
• Body Mass Index
• Age Factors
• Chest Tubes
• Tomography, X-Ray Computed
• Mitral Valve/surgery

• minimally invasive surgical procedures
• open window thoracostomy
• subcutaneous emphysema management
• three-sided taping
• vented chest seal
• wound protector/retractor

• Case report
• Gastric ulcer
• Mediastinal emphysema
• Perforated

• Causes
• Emphysème sous-cutané
• Pneumomédiastin secondaire
• Pneumomédiastin spontané
• Secondary pneumomediastinum
• Spontaneous pneumomediastinum
• Subcutaneous emphysema
• Traitement
• Treatment

• Subcutaneous emphysema
• intercostal drain
• mechanical ventilation
• nasogastric tube

• Barotrauma
• COVID-19
• Massive subcutaneous emphysema
• Minimally invasive techniques

Surgical emphysema refers to the presence of air within the subcutaneous space and is a known complication of chest drain insertion. Symptoms range from mild crepitus of the chest wall to the accumulation of air in the face and neck, which can ultimately result in cardiovascular compromise.

The aim of this article is to present a rare case of cervical, facial and periorbital surgical emphysema following chest drain insertion, and describes a novel use of ‘fish gill’ incisions in the palpebromalar groove with an associated review of the literature.

A 68-year-old gentleman presented with acute dyspnoea due to a right-sided tension pneumothorax. Emergency decompression with a Seldinger chest drain resulted in persistent cervical, facial and periorbital surgical emphysema causing difficulty in movement, inability to open the eyes and progressive risk to cervical venous return. “Fish gill’ incisions at the lateral-most edge of the palpebromalar groove, down to the level of the orbicularis oculi muscle, rapidly released air from the face and neck, alleviating discomfort, reducing venous compression and restoring vision.

Cervical, fascial and periorbital surgical emphysema may be resolved with the use of “fish gill” incisions at the lateral palpebromalar groove and simple drains. To the best of our knowledge, this method has not been reported previously in the literature.

• periorbital surgical emphysema
• tension pneumothorax
• ‘blow holes’
• ‘fish gills’

• acute medical emergencies management
• chest drain
• secondary pneumothorax
• subcutaneous drain
• surgical emphysema

Subcutaneous emphysema is an extremely rare complication after lobectomy. The current study aims to report a case of lung cancer developing extensive subcutaneous emphysema after lobectomy.

A 73-year-old man presented with dyspnea and cough for one month duration associated with wheeze and sputum. He was a chronic heavy smoker (100 pack/year). Work up revealed squamous cell carcinoma. Although he had poor pulmonary function tests, he underwent left upper lobectomy. On the fifth postoperative day, he was discharged from the hospital as there was no air leak and the lung remained expanded 15 hours after clamping of the thoracostomy tube. Two days later, the patient developed generalized subcutaneous emphysema. The patient was re-admitted to the hospital and a thoracostomy tube was inserted. The lung expanded upon insertion while the subcutaneous emphysema remained the same and even slightly increased over night. A 3 cm incision was made at the left infra-clavicular area and a negative pressure applied to it. The subcutaneous emphysema completely subsided a few hours after this intervention.

Because of the benign course, the majority of cases of subcutaneous emphysema (mild to moderate) only need nonoperative management alongside treatment of the predisposing factors. These patients may need nothing other than bed rest, good analgesia, supplemental oxygen, and reassurance.

Subcutaneous emphysema after lobectomy prolongs hospital stay. It mainly occurs in cases with poor pulmonary function tests, steroid use, and those with extensive adhesion.

•

Subcutaneous emphysema is one of the complications following thoracic surgery.

• Lobectomy
• Negative pressure
• Subcutaneous emphysema
• Surgical emphysema

• Post-operative management
• Post-operative subcutaneous emphysema
• Wound VAC placement

Vaping or E-cigarettes were created to deliver nicotine-containing aerosol to users with a flavoring agent without agents such as tars, oxidant gases, and carbon monoxide smoke found in traditional tobacco cigarettes. The use of E-cigarettes is steadily increasing in the United States, especially among the young population. Electronic cigarettes seem capable of causing various injury patterns in the lungs, collectively called E-cigarettes or vaping-associated lung injury (EVALI). Spontaneous pneumomediastinum (SPM) is a rare finding in EVALI. Here, we report a case of spontaneous pneumomediastinum secondary to vaping in a young man with no past medical history except for daily vaping and a recent untreated influenza infection.

This case reports on a critically ill patient (Male, 74) with severe subcutaneous emphysema which progressed to causing respiratory distress. We document both the severity of the condition we observed and then present a novel intervention. In this case, we decompressed the patient at the intensive care unit-bedside and resolved the condition. While subcutaneous emphysema is relatively common, the severity of the condition we observed, and the lack of definitive treatment guidance have prompted us to present this case as a plausible treatment guide.

• Subcutaneous emphysema
• decompression
• procedure
• respiratory distress

• Pneumocystis
• mediastinal emphysema
• negative-pressure wound therapy
• subcutaneous emphysema
• vacuum-assisted closure therapy

• Chest tube
• negative pressure wound therapy
• pneumothorax
• subcutaneous emphysema
• thoracic surgery

• Chest drainage
• computed tomography guided (CT guided)
• subcutaneous emphysema
• thoracic drainage
• tube thoracostomy
• video-assisted thoracic surgery

• Adult
• Delivery, Obstetric
• Diagnosis, Differential
• Female
• Humans
• Mediastinal Emphysema/diagnosis
• Mediastinal Emphysema/therapy
• Obstetric Labor Complications
• Oxygen Inhalation Therapy
• Pregnancy
• Puerperal Disorders/diagnosis
• Puerperal Disorders/therapy
• Subcutaneous Emphysema/diagnosis
• Subcutaneous Emphysema/therapy

In the acute management of a trauma patient, airway patency is of utmost importance. The present case describes a male patient who presented with delayed severe upper airway obstruction secondary to massive subcutaneous emphysema following blunt traumatic injury two days previously. Airway compromise is a rarely described but serious complication of subcutaneous emphysema. Current management of subcutaneous emphysema and its association with pneumothorax is summarized. Early decompression of underlying pneumothoraces in patients with significant subcutaneous emphysema should be performed to avoid this rare complication.

We present a case report of extensive subcutaneous emphysema secondary to an elective left upper lobectomy. A 65-year-old gentleman was brought into a London teaching hospital’s Accident and Emergency department following report of severe swelling. He was mistakenly treated by the paramedics as an allergic reaction and given hydrocortisone and salbutamol nebulisers with no effect. Upon arrival, the patient had widespread crepitus extending from his peri-orbital muscles down to mid-torso. A computer tomography scan revealed a pleuro-cutaneous fistula at the site of a recently sited chest drain, with extensive emphysema and a pneumothorax. A Seldinger chest drain was successfully inserted under blind technique following two attempts. This case highlights the risk of subcutaneous emphysema following thoracic surgery, the importance of correct diagnosis and the difficulties of left-sided intercostal drains in patients with subcutaneous emphysema.

• Surgery
• cardiothoracic
• critical care/emergency medicine
• radiology
• subcutaneous emphysema

Subcutaneous emphysema may aggravate traumatic pneumothorax treatment, especially when mechanical ventilation is required. Expectative management usually suffices, but when respiratory function is impaired surgical treatment might be indicated. Historically relevant methods are blowhole incisions and placement of various drains, often with related wound complications. Since the first report of negative pressure wound therapy for the treatment of severe subcutaneous emphysema in 2009, only few publications on use of commercially available sets were published. We report on patient injured in a motor vehicle accident who had serial rib fractures and bilateral pneumothorax managed initially in another hospital. Due to respiratory deterioration, haemodynamic instability and renal failure patient was transferred to our Intensive Care Unit. Massive and persistent subcutaneous emphysema despite adequate thoracic drainage with respiratory deterioration and potentially injurious mechanical ventilation with high airway pressures was the indication for active surgical treatment. Negative-pressure wound therapy dressing was applied on typical blowhole incisions which resulted in swift emphysema regression and respiratory improvement. Negative pressure wound therapy for decompression of severe subcutaneous emphysema represents simple, effective and relatively unknown technique that deserves wider attention.

• Negative-pressure wound therapy
• Pneumothorax
• Respiratory insufficiency
• Subcutaneous emphysema
• Vacuum-assisted closure

• Aged
• Heart Arrest/etiology
• Humans
• Male
• Postoperative Complications/etiology
• Respiratory Insufficiency/etiology
• Subcutaneous Emphysema/etiology
• Thoracoscopy

Organizing pneumonia (OP) is a less common interstitial lung disease with varying clinical picture. The development of pulmonary air leak in a case of OP is an extremely rare complication. Here, we report the case of a 46-year-old female with carcinoma ovary, postchemotherapy who developed respiratory distress with pneumomediastinum, and subcutaneous emphysema. Lung biopsy showed evidence of OP. This turned out to be a rare case of OP, secondary to bleomycin chemotherapy, presenting with pulmonary air leak.

• Air leak
• bleomycin chemotherapy
• lung biopsy
• organizing pneumonia
• subcutaneous emphysema

• Emphysema
• Lung cancer
• Pneumothoraces

•

Iatrogenic pneumothorax should be anticipated during and after a CT guided transthoracic needle biopsy and actively treated.

Subcutaneous emphysema is a common complication of tube thoracostomy. Though self-limiting, it should be treated when it causes palpebral closure, dyspnea, dysphagia or undue disfigurement resulting in anxiety and distress to the patient.

A 72 year old man who was a known case of COPD on bronchodilators developed a large pneumothorax and respiratory distress after a CT guided transthoracic lung biopsy done for a lung opacity (approx. 3 × 3 cm) at the right hilar region on Chest X-ray. Within 24 h of an urgent tube thoracostomy, patient developed intractable subcutaneous emphysema with closure of palpebral fissure and dyspnea unresponsive to increasing suction on chest tube. A subcutaneous fenestrated drain was placed mid-way between the nipple and clavicle in the mid-clavicular line bilaterally. Continuous negative suction (-150 mmHg) resulted in immediate, sustained relief and complete resolution within 5 days.

Extensive and debilitating SE (subcutaneous emphysema) has to be treated promptly to relieve patient discomfort, dysphagia or imminent respiratory compromise. A variety of treatment have been tried including infraclavicular blow-hole incisions, subcutaneous drains +/− negative pressure suction, fenestrated angiocatheters, Vacuum assisted dressings and increasing suction on a pre-existing chest tube. We describe a high negative pressure subcutaneous suction drain which provides immediate and sustained relief in debilitating SE.

Debilitating subcutaneous emphysema which causes distress, anxiety, palpebral closure, dyspnoea or dysphagia requires intervention. High negative pressure subcutaneous suction drain provides immediate and sustained relief in extensive and debilitating SE.

• Case report
• Pneumothorax
• Subcutaneous emphysema
• Tube thoracostmy

We present a case of a gentleman in his 70s with extensive subcutaneous emphysema. Usually self-limiting, subcutaneous emphysema around the thoracic inlet can rarely lead to airway and cardiovascular compromise by compression of structures in the neck. This patient presented with a large pneumothorax on a background of chronic obstructive pulmonary disease (COPD). This was initially treated with an intrapleural chest drain. However, after removal of this drain, the patient developed subcutaneous emphysema and later signs of tension pneumothorax. Further intrapleural chest drains were required. One of these chest drains produced a broncho-subcutaneous fistula, which contributed to extensive subcutaneous emphysema. He developed symptoms of dysphonia and dysphagia. A subcutaneous drain was inserted for palliation of his symptoms and to improve his quality of life. His symptoms improved significantly after insertion of this subcutaneous drain. There are only a handful of case reports published on interventions to relieve subcutaneous emphysema.

• Chronic obstructive pulmonary disease
• lung injury
• pneumothorax
• subcutaneous emphysema
• subcutaneous tissue

Spontaneous pneumomediastinum is an uncommon event, the clinical picture of which includes retrosternal chest pain, subcutaneous emphysema, dyspnea, and dysphonia. The pathophysiological mechanism involved is the emergence of a pressure gradient between the alveoli and surrounding structures, causing alveolar rupture with subsequent dissection of the peribronchovascular sheath and infiltration of the mediastinum and subcutaneous tissue with air. Known triggers include acute exacerbations of asthma and situations that require the Valsalva maneuver. We described and documented with HRCT scans the occurrence of pneumomediastinum after a patient with bleomycin-induced interstitial lung disease underwent pulmonary function testing. Although uncommon, the association between pulmonary function testing and air leak syndromes has been increasingly reported in the literature, and lung diseases, such as interstitial lung diseases, include structural changes that facilitate the occurrence of this complication.

• Mechanical ventilation
• Negative pressure wound therapy
• Subcutaneous emphysema

• Device
• Negative pressure
• Subcutaneous emphysema

• Classification
• Infraclavicular incisions
• Management
• Subcutaneous emphysema

• blow holes
• gills
• pneumomediastinum
• subcutaneous emphysema
• tension physiology

The occurrences of pneumothorax and pneumomediastinum are rare, but considered to be potentially life-threatening conditions in patients undergoing functional endoscopic sinus surgery under general anesthesia. Tracheobronchial rupture may results in serious complications, such as pneumothorax and pneumomediastinum. It may occur accidentally by endotracheal tube when the patient's neck is flexed or extended. We report the case of a 48-year-old female patient who developed massive subcutaneous emphysema, pneumothorax, pneumomediastinum and pneumoperitoneum seven hours after functional endoscopic sinus surgery under general anesthesia.

• Pneumomediastinum
• Pneumothorax
• Tracheobronchial rupture
• Valsalva maneuver

Spontaneous pneumomediastinum associated with subcutaneous emphysema is a rare condition also known as Hamman's syndrome. It can also be seen postpartum. We present two cases of subcutaneous emphysema associated with childbirth in nulliparous women, both of which resolved spontaneously.

Subcutaneous tissue emphysema is observed in a several clinical settings but spontaneous subcutaneous emphysema in the absence of pneumothorax with broncho pleuro subcutaneous fistula is rare. We report a case of spontaneous subcutaneous emphysema secondary to cavitary pulmonary tuberculosis in the absence of pneumothorax.

• Air leak
• Pulmonary tuberculosis
• Subcutaneous emphysema

• Air leak
• pulmonary tuberculosis
• subcutaneous emphysema