A study of subcutaneous emphysema, factors contributing to its development, resolution and management with different modalities

Submitted: March 15, 2023
Accepted: June 6, 2023
Published: June 26, 2023
Abstract Views: 755
PDF: 137
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Subcutaneous emphysema (SE) is defined as an escape of air in subcutaneous tissue. It is one of the most common complications after intercostal chest tube drainage. SE is usually benign, requiring no specific treatment, but extensive SE can be uncomfortable and alarming for the patient. It can rarely lead to airway compromise, respiratory failure, and death. Factors leading to its development, following chest tube insertion and methods of management, have not been extensively studied and published. This was an analytical study done over 2 years on indoor patients who developed SE. These cases were managed using four different modalities and were analyzed for various factors contributing to the development, severity, and resolution of SE. The results of this study highlight that the cases of hydropneumothorax and secondary pneumothorax were significantly more predisposed to the development of severe SE (following intercostal chest tube insertion) and large air leaks as compared to others. A larger air leak develops higher grades of SE. The average time for resolution of SE was similar among the different modalities of management compared in the study.



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Maunder RJ, Pierson DJ, Hudson LD. Subcutaneous and mediastinal emphysema. Pathophysiology, diagnosis, and management. Arch Intern Med 1984;144:1447-53.
Agrawal A, Sen KK, Satapathy G, et al. Spontaneous pneumomediastinum, pneumothorax and subcutaneous emphysema in COVID-19 patients—a case series. Egypt J Radiol Nucl Med 2021;52:27.
Raykar PS, Banur A, Mahanthappa G, et al. J. Characteristics and outcome of pneumothorax, pneumomediastinum, and subcutaneous emphysema in COVID-19 patients: a case series. J Assoc Chest Physicians 2023;11:28-35.
Macklin MT, Macklin CC. Malignant interstitial emphysema of the lungs and mediastinum as an important occult complication in many respiratory diseases and other conditions. Medicine (Baltimore) 1944;23:281-358.
Chan L, Reilly KM, Henderson C, et al. Complication rates of tube thoracostomy. Am J Emerg Med 1997;15:368-70.
Fidrocki DM, Greenbaum NR, Diaz GC. Severe pneumomediastinum and subcutaneous emphysema subsequent to prolonged mechanical ventilation. IDCases 2021;24:e01090.
Johnson CH, Lang SA, Bilal H, Rammohan KS. In patients with extensive subcutaneous emphysema, which technique achieves maximal clinical resolution: infraclavicular incisions, subcutaneous drain insertion or suction on in situ chest drain?. Interact Cardiovasc Thorac Surg 2014;18:825-9.
Ruan G, Edquist C, Pagali S. Extensive subcutaneous emphysema: a complication of traumatic pneumothorax. JAAPA 2021;34:52-4.
Ali RK, Kakamad FH, Hama Ali Abdalla S, et al. Management of post lobectomy subcutaneous emphysema: a case report with literature review. Ann Med Surg (Lond) 2021;69:102610.
Aghajanzadeh M, Dehnadi A, Ebrahimi H, et al. Classification and management of subcutaneous emphysema: a 10-year experience. Indian J Surg 2015;77:673-7.
Oh SG, Jung Y, Jheon S, et al. Postoperative air leak grading is useful to predict prolonged air leak after pulmonary lobectomy. J Cardiothorac Surg. 2017;12:1.
Laws D, Neville E, Duffy J. BTS guidelines for the insertion of a chest drain. Thorax 2003;58:ii53-9.
Dixit R, Meena M, Patil CB. Pneumomediastinum, bilateral pneumothorax and subcutaneous emphysema complicating acute silicosis. Int J Occup Med Environ Health 2015;28:635-8.
Dixit R, George J. Subcutaneous emphysema in cavitary pulmonary tuberculosis without pneumothorax or pneumomediastinum. Lung India 2012;29:70-2.
Das M, Chandra U, Natchu M et al. Pneumomediastinum and subcutaneous emphysema in acute miliary tuberculosis. Indian J Pediatr 2004;71:553-4.
Jones PM, Hewer RD, Wolfenden HD, Thomas PS. Subcutaneous emphysema associated with chest tube drainage. Respirology 2001;6:87-9.
Lloyd MS, Jankowksi MP. Treatment of life-threatening surgical emphysema with liposuction. Plast Reconstr Surg 2009;123:77e-8e.
Beck PL, Heitman SJ, Mody CH. Simple construction of a subcutaneous catheter for treatment of severe subcutaneous emphysema. Chest 2002;121:647-9.
Kelly MC, McGuigan JA, Allen RW. Relief of tension subcutaneous emphysema using a large bore subcutaneous drain. Anaesthesia 1995;50:1077-9.
Chari M R, Leo S, Priya A R. Simple micro drainage system for palliation of severe subcutaneous emphysema. Trop Doct 2022;52:408-10.
Cesario A, Margaritora S, Porziella V, Granone P. Microdrainage via open technique in severe subcutaneous emphysema. Chest 2003;123:2161-2.
Sherif HM, Ott DA. The use of subcutaneous drains to manage subcutaneous emphysema. Tex Heart Inst J 1999;26:129-31.

Ethics Approval

The study was approved by the Institutional Ethics Committee.

How to Cite

Goyal, Mukesh, Jose K. Jimmy, Ramakant Dixit, and Deepak Kumar Garg. 2023. “A Study of Subcutaneous Emphysema, Factors Contributing to Its Development, Resolution and Management With Different Modalities”. Monaldi Archives for Chest Disease 94 (2). https://doi.org/10.4081/monaldi.2023.2583.