Subcutaneous Emphysema

What is Subcutaneous Emphysema?

Subcutaneous emphysema is a condition that occurs when air gets into the tissue beneath the skin. Subcutaneous emphysema consist of the words subcutaneous which refers to the tissue beneath the skin, whereas emphysema refers to trapped air. This condition is also known as tissue emphysema.

subcutaneous emphysema photos

Signs & Symptoms

Signs and symptoms of subcutaneous emphysema vary depending on the cause but it can be quite asymptomatic and includes the following:

  • Swelling of the neck and chest pain
  • It may also include sore throat or tonsillitis
  • Neck pain
  • Difficulty swallowing
  • Wheezing and difficulty breathing
  • Touching the overlying skin it feels like tissue paper or Rice Krispies and can cause a crackling sound as the gas is being pushed within the tissue. The air bubbles are painless and feel like small nodules that are smooth to the touch.
  • The tissue around the subcutaneous emphysema are usually swollen.
  • The face may also swell incase the level of air leakage into the tissues is high.
  • Where the subcutaneous emphysema is around the neck, there may be a feeling of fullness around the neck and the voice may also change
  • Swelling may also occur in other parts of the body other than the neck and chest region. For example, you may experience swelling in parts like the abdomen and the limbs as there are no separations in the fatty tissue of the skin to restrict the air from moving.
  • Chest X-rays may also show air in the middle of the chest cavity.

Causes

Subcutaneous emphysema is a rare condition and when it occurs some of the possible causes include the following:

  • Chest trauma is one of the major causes of subcutaneous emphysema causing air to enter the skin in the chest through the lung or neck. When the pleural membranes are ruptured as it occurs during penetrating trauma of the chest, air may move from your lungs to the muscles and subcutaneous tissue of the chest wall.

When the alveoli of the lung are ruptured as is the case in pulmonary laceration air may travel beneath the membrane lining the lung, visceral pleura, to the hilum of the lung, further up to the trachea then to the neck and into the chest wall.

Rib fractures may also tear the membrane lining the inside of the chest wall, the parietal pleura and therefore allowing air to escape into the subcutaneous tissues. Chest trauma can be caused by accidents, gunshot wounds, stab wounds or wounds to the chest from being hit with a blunt object.

  • During asthma attacks
  • During child birth
  • During dental surgery by using high speed tools that are air driven, although this happens infrequently it may result to swelling in the neck and face as well as the onset of the crackling sound which is typical of subcutaneous emphysema
  • When the Heimlich maneuver is used, the Heimlich maneuver is a first aid procedure that consists of abdominal thrusts aimed at dislodging objects that are obstructing the tracheal air way
  • When excessive pressure also known as barotrauma, such as experienced during diving and it damages the lungs allowing air to escape into the chest lining
  • Hamman’s syndrome, which can result from a number of factors one of which is the aspiration of a foreign body, where the object inhaled punctures the airways or increases pressure within the damaged lung significantly to cause them to burst and allowing air to escape into the surrounding tissue.
  • Fracture of the facial bones
  • Breathing in cocaine
  • Corrosive or chemical burns to the esophagus
  • Pertussis, also referred to as whooping cough
  • Forceful vomiting, also referred to as Boerhaave syndrome
  • Certain medical procedures that involve insertion of a tube into the body such as in endotracheal intubation where a tube is placed into the throat and the trachea through the mouth and nose and bronchoscopy where a tube is placed into the bronchial tubes through the mouth. In a situation such as endotracheal intubation when such a tube is being placed if it pierces the tracheal cavity large amounts of air can enter the subcutaneous tissue.
  • Necrotizing infections can also cause air to be trapped within the skin, infections like gas gangrene cause subcutaneous emphysema.
  • Activities like scuba diving can also cause air to get into the subcutaneous tissue.
  • Tension pneumothorax where after injury air builds up outside the lung within the chest cavity and therefore exerting pressure on the organs within the chest increasing the likely hood of air making its way into the subcutaneous tissue through pleura torn by a broken rib. When pneumothorax is the main cause of subcutaneous emphysema air may enter tissues within the face, chest, armpits, neck or abdomen.

subcutaneous emphysema causes

Treatment

Subcutaneous emphysema is usually benign and most of the time it does not need treatment however if the amount of air trapped within the subcutaneous tissue is large, it may result to discomfort as well as difficulty breathing. This may therefore warrant grounds for treatment. Some of the ways of treating subcutaneous emphysema include:

  • Surgical drainage may be done especially where the air pushed out of the lung causes pressure that impedes blood flow to the areolae of the breast and skin of the labia or scrotum
  • In case of a severe subcutaneous emphysema, then catheters may be placed into the subcutaneous tissue to release the air
  • Small cuts which are known as “blow holes” can also be made in the skin to release the gas
  • Resting in bed, taking of medication to control the pain as well as taking supplemental oxygen are means of treating subcutaneous emphysema. Breathing in oxygen may help the body to more quickly absorb the subcutaneous air.
  • Where the subcutaneous emphysema is caused by pneumothorax, air outside the lung causing pressure on the organs in the chest, a tube may be inserted into the chest to pump out the air through suction.

Conclusion

Although subcutaneous emphysema is usually benign the underlying conditions that are causing it may be quite severe and should be treated by a health care provider. The case is even more severe in case of trauma and the person should not be moved unless the environment is hazardous, and health care should be looked for immediately.

References

  1. https://medlineplus.gov/ency/article/003286.htm
  2. http://howshealth.com/subcutaneous-emphysema/
  3. Subcutaneous Emphysema. Available at http://www.dovemed.com/diseases-conditions/subcutaneous-emphysema/

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