Summary about Disease
Subcutaneous emphysema (SCE), also known as surgical emphysema, is a condition where air becomes trapped under the skin. This usually occurs in the chest, neck, and face, but can spread to other parts of the body. The presence of air under the skin produces a characteristic crackling sensation when palpated (felt), often described as "crepitus." While not usually life-threatening on its own, its presence often indicates an underlying medical issue that requires prompt diagnosis and treatment.
Symptoms
Crepitus: A crackling or popping sensation under the skin when touched, due to the presence of air bubbles.
Swelling: Noticeable swelling in the affected area (neck, chest, face, etc.).
Pain or Discomfort: May experience pain or discomfort in the affected area.
Voice Changes: Hoarseness or difficulty speaking, especially if the emphysema is in the neck.
Difficulty Breathing: Can occur if the emphysema is extensive or compressing the airway.
Feeling of Fullness: A sensation of fullness or pressure in the affected area.
Causes
Trauma: Injury to the chest, neck, or face, such as a blunt force trauma, stab wounds, or fractures.
Surgery: After certain surgical procedures, particularly those involving the chest, neck, or lungs.
Lung Problems: Pneumothorax (collapsed lung), ruptured blebs (air sacs in the lung), or barotrauma (injury from pressure changes).
Esophageal Rupture: Boerhaave syndrome (spontaneous rupture of the esophagus) or injury to the esophagus.
Infections: Gas-producing infections, such as necrotizing fasciitis.
Mechanical Ventilation: Can occur as a complication of positive pressure ventilation.
Dental Procedures: Air forced into tissues during certain dental procedures, such as the use of high-speed drills.
Medicine Used
Pain relievers: To manage pain and discomfort. These could range from over-the-counter medications like acetaminophen or ibuprofen to stronger prescription pain relievers if necessary.
Antibiotics: If the subcutaneous emphysema is caused by a bacterial infection, antibiotics will be prescribed to treat the infection.
Oxygen therapy: Supplemental oxygen may be administered to improve oxygenation, especially if there is difficulty breathing.
Bronchodilators: If lung problems are contributing to the condition (e.g., asthma exacerbation with alveolar rupture), bronchodilators might be used.
No Specific Medication: In many cases, the subcutaneous emphysema itself does not require medication. Treatment focuses on addressing the underlying cause.
Is Communicable
Subcutaneous emphysema is not communicable. It is not an infectious disease and cannot be spread from person to person. It is a condition resulting from air trapped beneath the skin due to an underlying cause.
Precautions
Treat Underlying Cause: The primary precaution is to identify and treat the underlying medical condition causing the subcutaneous emphysema.
Monitor Breathing: Closely monitor the patient's breathing and oxygen levels.
Avoid Activities That Increase Pressure: Avoid activities that increase pressure in the chest or airways, such as forceful coughing or straining.
Wound Care: If the emphysema is related to a wound, ensure proper wound care to prevent infection.
Medical Alert: If you've experienced SCE, inform medical professionals during future procedures/consultations.
How long does an outbreak last?
The duration of subcutaneous emphysema varies greatly depending on the underlying cause and the extent of the air leak. Mild cases may resolve within a few days with treatment of the underlying condition. More severe cases, especially those related to significant trauma or lung injury, may take weeks or even months to fully resolve. The air is typically reabsorbed by the body over time. If the underlying cause isn't addressed, it can persist or worsen.
How is it diagnosed?
Physical Examination: Palpation of the affected area to detect crepitus is a key finding.
Medical History: A thorough review of the patient's medical history, including recent surgeries, trauma, or lung problems.
Imaging Studies:
Chest X-ray: To visualize the presence of air in the subcutaneous tissues and to identify underlying lung pathology.
CT Scan: Provides a more detailed view of the chest and neck, helping to identify the source of the air leak and assess the extent of the emphysema.
Esophagography/Bronchoscopy: May be necessary to rule out esophageal or airway injury.
Timeline of Symptoms
The onset of symptoms can vary based on the cause:
Immediate: Following trauma or surgery, symptoms may appear almost immediately.
Gradual: In cases of spontaneous pneumothorax or esophageal rupture, the onset may be more gradual, developing over hours to days.
Progression: The extent of the subcutaneous emphysema can worsen over time if the underlying cause is not addressed.
Resolution: With successful treatment of the underlying cause, the air will gradually be reabsorbed, and the swelling and crepitus will decrease.
Important Considerations
Airway Compromise: Subcutaneous emphysema in the neck can potentially compromise the airway, requiring immediate intervention.
Underlying Cause: Identifying and treating the underlying cause is crucial for resolving the emphysema and preventing complications.
Pneumothorax: Subcutaneous emphysema can be a sign of a pneumothorax, which may require drainage.
Infection: Rule out infection as a cause, particularly if there are signs of inflammation or fever.
Consult a Specialist: Consult with a pulmonologist or surgeon to properly diagnose and manage the condition.