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Abstract
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Background and Aims Subcutaneous emphysema (SE) is a finding of gas within the subcutaneous soft tissues, usually in the chest or neck. There are numerous causes for this phenomenon, including blunt and penetrating trauma, soft tissue infection, and surgical instrumentation.
Methods We present the case of a 39-year-old man with cervical SE and pneumomediastinum after penetrating cervical trauma due to attempted suicide. A cervical-thoracic CT showed the presence of pneumomediastinum and significant cervical subcutaneous emphysema. As a preventive measure, the patient was admitted to the Resuscitation Unit to ensure the airway through orotracheal intubation. He was kept under sedation for 48 hours and broad-spectrum empirical antibiotic therapy was prescribed. After this time, the CT was repeated and, given the marked decrease in emphysema, the patient was extubated without incident.
Results SE occurs when air becomes trapped under the skin. Air forced into the interstitial tissues around the pulmonary vasculature travels back toward the hilum, leading to pneumomediastinum, and this eventually spreads to the soft tissues of the neck, face, and chest wall. In our patient, penetrating trauma was the event that caused the entry of air into the tissues. In most cases, it does not involve airway compromise as subcutaneous air easily accommodates the distensible subcutaneous tissues and conservative treatment is adequate. Subcutaneous drainage or supraclavicular incisions are safe techniques with no reported complications (2).
Cervical thoracic CT: significant subcutaneous emphysema extending from the prevertebral space at the level of the oropharynx to the mediastinum (anterior and posterior)
Cervical-thoracic CT (after 48h): Marked decrease in subcutaneous emphysema compared to previous study, predominantly in the left supraclavicular fossa
Conclusions SE is usually not necessarily dangerous, and conservative treatment is usually sufficient. However, on occasions like the case presented here, it can compromise the airway and require invasive therapeutic measures.