Surgical Emphysema without Pneumothorax: A Diagnostic Dilemma

Dinesh Kumar Sathanantham; Spurthi Sanganbhonia; C. A. Shashirekha; P. N. Sreeramulu

doi:10.30702/ujcvs/23.31(02)/KSS012-8588

Dinesh Kumar Sathanantham Government Medical College, Kottayam, Kerala, India; Sri Devaraj Urs Medical College, Tamaka, Kolar, Karnataka, India https://orcid.org/0000-0002-7142-3348
Spurthi Sanganbhonia Sri Devaraj Urs Medical College, Tamaka, Kolar, Karnataka, India https://orcid.org/0000-0001-7639-1915
C. A. Shashirekha Sri Devaraj Urs Medical College, Tamaka, Kolar, Karnataka, India https://orcid.org/0000-0003-3554-6268
P. N. Sreeramulu Sri Devaraj Urs Medical College, Tamaka, Kolar, Karnataka, India https://orcid.org/0000-0002-9445-0891

DOI: https://doi.org/10.30702/ujcvs/23.31(02)/KSS012-8588

Keywords: subcutaneous emphysema, Mackler effect, thoracic trauma, road traffic accident, scalp injury

Abstract

Surgical emphysema, also widely known as subcutaneous emphysema, is defined as a clinical state in which air gets trapped subcutaneously. The etiology may be traumatic or atraumatic, and multiple causes in each are present.

Case report. A 63-year-old female patient presented to the emergency room with a facial soft tissue injury following road traffic accident and developed surgical emphysema later on with no evidence of rib fractures or pneumothorax. Infectious etiology was ruled out. Due to the respiratory embarrassment, the patient was electively intubated. Conservative management was provided. Emphysema resolved within 24 hours after the accident.

Discussion. Various theories have been outlined in literature, like Mackler effect, Crampton theory and ballvalve mechanism. In our case, it was difficult to apply any of these theories to confirm the diagnosis. Conservative management is still used in the treatment of surgical emphysema.

Conclusion. Surgical emphysema is a common encounter in trauma practice, and its identification is essential to rule out any emergency causes which may lead to respiratory distress.

References

Parker GS, Mosborg DA, Foley RW, Stiernberg CM. Spontaneous cervical and mediastinal emphysema. Laryngoscope. 1990;100(9):938-940. https://doi.org/10.1288/00005537-199009000-00005
Aghajanzadeh M, Dehnadi A, Ebrahimi H, Fallah Karkan M, Khajeh Jahromi S, Amir Maafi A, et al Classification and Management of Subcutaneous Emphysema: a 10-Year Experience. Indian J Surg. 2015;77(Supl 2):673-677. https://doi.org/10.1007/s12262-013-0975-4
Venugopal K, Reddy MM, Bharathraj Y M, Kadappa J. Non-traumatic, spontaneous subcutaneous emphysema: Diagnostic and therapeutic dilemma. Int J Health Allied Sci. 2015;4(2):97-99.
De M, Stevenson J. Subcutaneous emphysema of upper limb. Emerg Med J. 2001;18(6):522. https://doi.org/10.1136/emj.18.6.522
Rabiul Islam SM, Mamman KG, Pande KC. Benign Subcutaneous Emphysema of the Upper Limb: A Case Report. Malays Orthop J. 2016;10(3):39-41. https://doi.org/10.5704/MOJ.1611.002
Tewari SO, Faroqui RM, Fuca N, Khan M, Mantello MT. Spontaneous subcutaneous emphysema of the scalp following hair coloring/treatment. Radiol Case Rep. 2017;12(1):78-80. https://doi.org/10.1016/j.radcr.2016.11.007
Sinnatamby CS. Last’s anatomy: regional and applied. 12th ed. Edinburgh: Churchill Livingstone/Elsevier;2011.
O’Reilly P, Chen HK, Wiseman R. Management of extensive subcutaneous emphysema with a subcutaneous drain. Respirol Case Rep. 2013;1(2):28-30. https://doi.org/10.1002/rcr2.9