Managing iatrogenic subcutaneous emphysema on a background of COPD while treating persistent secondary pneumothorax

Respiratory Department, NHS, Sussex, UK.
Case Reports 08/2010; 2010. DOI: 10.1136/bcr.09.2009.2283
Source: PubMed


This is a case of a 77-year-old gentleman with severe smoking related chronic obstructive airways disease (COPD) who presented with a secondary pneumothorax. Attempts to treat a persistent air leak using (IC) drains of increasing size led to sudden worsening of iatrogenic subcutaneous emphysema. A CT scan performed confirmed the presence of a pneumomediastium and florid subcutaneous emphysema in the face and torso. Although the patient reported a change in voice with hoarseness there was no evidence of airway compromise. The patient was conservatively managed in the high-dependency unit. He was not considered fit enough to undergo general anaesthesia and surgery; therefore, a pleurodesis using sterile talc was undertaken. The IC drain was successfully removed, following resolution of the air leak, and the lung remained re-inflated. His subcutaneous emphysema gradually spontaneously resolved with no further complications.

25 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Spontaneous rupture of the pulmonary alveoli after a sudden increase in intra-alveolar pressure is a common cause of pneumomediastinum, which is usually seen in healthy young men. Other common causes are traumatic and iatrogenic rupture of the airway and esophagus; however, pneumomediastinum following cervicofacial emphysema is much rarer and is occasionally found after dental surgical procedures, head and neck surgery, or accidental trauma. We present four cases of subcutaneous emphysema and pneumomediastinum with two secondary pneumothoraces after self-induced punctures in the oral cavity. They constitute an uncommon clinical entity that, to our knowledge, has not been reported in the literature. Its radiologic appearance, clinical presentation, and diagnosis are described.
    Chest 08/2001; 120(1):306-9. DOI:10.1378/chest.120.1.306 · 7.48 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: These guidelines have been replaced by BTS Pleural Disease Guideline 2010 Superseded By BTS Pleural Disease Guideline 2010: BTS Guidelines for the Management of Pleural Disease. Thorax 2003 May; 58(Suppl 2): 1–59.
    Thorax 06/2003; 58 Suppl 2(Suppl 2):ii53-9. DOI:10.1136/thx.58.suppl_2.ii53 · 8.29 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Subcutaneous emphysema is a physical finding that itself is usually perceived as benign yet rarely may, in and of itself, be life-threatening. We present an unusual case of a 67-year-old woman who developed delayed severe subcutaneous emphysema and tension pneumothorax from a rib fracture subsequent to a fall. We review the pathophysiology, manifestations and management options of this disorder. In patients whose clinical condition allows it, chest tube placement prior to intubation should be considered. Furthermore, positive end-expiratory pressure should be minimized. We present a case that illustrates how subcutaneous emphysema itself can be a potential cause of respiratory failure and tamponade physiology. In our case, a patient with traumatic subcutaneous emphysema developed respiratory failure and clinical deterioration after the introduction of positive pressure ventilation. In such rare scenarios, care should be taken to consider the absolute need for positive pressure ventilation without surgical decompression.
    Canadian Journal of Emergency Medicine 07/2008; 10(4):387-91. · 1.16 Impact Factor
Show more


25 Reads
Available from