What is Subcutaneous Emphysema?
A rare compulsive build-up of effervesces of air or gases like carbon dioxide trapped within the hypodermic tissue is termed as subcutaneous emphysema. It is observed as bloating of the skin around the neck and covering of the chest wall. On palpation of the skin, an unfamiliar crackling sound is produced as the bubbles are pressed through the tissues. The condition is not painful in general, even though it may feel like uneven nodes or lumps and this particular sensation of fluid underneath the cutis of the skin is called as subcutaneous crepitation. The excess accumulation of the fluid in the chest and neck can be fatal to life due to restriction of air passage.
Subcutaneous Emphysema Symptoms
The most common and visible sign and symptom of subcutaneous emphysema is inflammation around the neck accompanied with pain in chest. Other symptoms include a tender sore throat, aching neck, trouble in swallowing, breathlessness and wheezing. Diagnosis with X-ray of chest shows air bubbles right in the middle of the chest cavity which is the mediastinum. The best and the easiest way to diagnose subcutaneous emphysema are by physically touching of the skin covering the neck and chest. Due to this touching, the bubbles are made to push across the underlying tissue and a sound similar to touching of Rice Krispies or tissue paper is produced.
The condition is painless but in severe cases upon seepage of excess amount of air in the tissue, swelling of the face to a considerable amount can occur, which is also one of the subcutaneous emphysema symptoms. Even the neck will be swelled and there might be a change in voice too. In more serious condition, the air is capable of spreading to different parts of the body like the limbs and abdomen. This is due to the fact that there are no separations in the adipose tissue underneath the skin restricting the passage of air and preventing its further movement.
Subcutaneous Emphysema Causes
One of the basic causes of subcutaneous crepitation is the seepage of air through the lacerations on skin caused by stabbing, blunt trauma or bullet wounds. Due to the muscular movements the air is readily drawn in and rapidly spreads to the neck and chest cavity. A ruptured bronchial tube, esophagus and a buckled lung are other reasons for this condition.
Following are the subcutaneous emphysema causes discussed in detail;
Subcutaneous emphysema pneumothorax occurs when the pleural cavity of the chest which is in betwixt the chest wall and the lungs is filled with gas or air. There is pressure against the lung and it can lead to its partial or complete collapse. There might be no specific reason of this condition apart from one being an injury to the chest. Coughing, unilateral chest pain and restlessness might be suffered by the patient. The sound of breaths being taken is either alleviated or absent on the affected side.
Bronchial tube rupture
this is the rupture of the trachea leading to shortness of breath or dyspnea leading to sudden subcutaneous crepitation. Tachycardia, hypotension, extreme restlessness and a possible hemoptysis is the typical signs of bronchial rupture.
there can be perforation or rupture of the esophagus due to the use of medical instruments used for diagnostic purposes. Other cause can be postoperative trauma or some disease pertaining to esophagus. The condition is rare and affects only 3 in 100,000. If caught, it can cause local tenderness, extreme pain in the neck and orthostatic vertigo. Disproportionate expansion of the chest along with nasal flaring and fever is also present.
it is extremely rare but highly dangerous invasion of the skin over a wound by anaerobic microorganisms. The ruptured skin will expose black and red necrotic muscles accompanied with a foul odor of a watery discharge. Cyanosis, fever, inflammation and pain are prominent.
Subcutaneous Emphysema Treatment
As in such there is no particular treatment of this condition apart from the fact that an incision or catheters are placed in the skin in order to release the air confined in the chest cavity. This is called aerodermectasia. Even lung transplant is done sometimes. This is done in severe case of crepitation, while in moderate case; supplemental oxygen is provided via masks to combat the shortness of breath as felt by the patient. The doctor will give advice to refrain from smoking and avoid areas polluted with dust and fumes.
Subcutaneous Emphysema Chest Tube
When pneumothorax is the cause of emphysema, then a subcutaneous emphysema chest tube is used to keep a tab on the situation. Due the placement of a chest tube, the source via which air is entering is eliminated. If the amount of air seeping in is increasing then the existing tube can be replaced by a larger one.