An Overview of Subcutaneous Emphysema

Subcutaneous emphysema is a rare condition in which air becomes trapped under the skin. This is most likely to occur in the chest, neck, and face, but it can happen in any part of the body. Specifically, the air is trapped in the innermost of the skin's three layers, known as the subcutaneous layer.

Subcutaneous emphysema can be caused by medical procedures, surgeries, accidents, injuries, or infections. Symptoms can vary, but swelling and a crackling noise when the skin is touched are considered standard.

This type of emphysema is unlike the other form of emphysema—a type of chronic obstructive pulmonary disease (COPD) often caused by smoking.

This article explains the symptoms and causes of subcutaneous emphysema. It will also discuss how it's diagnosed, treatment options, and tips for coping with the condition.

Causes of Subcutaneous Emphysema

There are numerous underlying causes of subcutaneous emphysema, including:

• Injuries to almost any part of the body, especially the chest, sinuses, or facial bones
• Pneumothorax
• Infection with necrotizing bacteria that kills skin tissue, increasing the risk of gangrene
• Surgical trauma
• Laparoscopic surgeries
• Barotrauma (also called "the bends" that can occur in scuba divers or from other activities that subject a person to extreme altitude changes)
• Accidental injury to the trachea during intubation (insertion of a breathing tube)
• Ventilator malfunctions or issues
• Injuries to the esophagus (often occur during the insertion of a feeding tube)
• Bowel or esophageal perforations
• Bag mask ventilation during cardiopulmonary resuscitation (CPR)

Rarely, subcutaneous emphysema may occur for no known reason. This is referred to as spontaneous subcutaneous emphysema.

Subcutaneous emphysema is more common in men than in women.

Subcutaneous Emphysema Symptoms

Symptoms of subcutaneous emphysema can range from mild to severe. It's also possible not to have any symptoms at all. More severe cases can lead to significant discomfort and serious complications.

Symptoms vary depending on the underlying cause and where in the body it is located. However, almost all people with subcutaneous emphysema will experience:

• Edema (swelling) in the affected area
• Crepitus, a crackling sound when the surface of the skin is examined by touch

Crepitus may be the sign that leads medical professionals to diagnose subcutaneous emphysema.

Other symptoms of subcutaneous emphysema may include:

• Sore throat
• Neck pain
• Difficulty breathing
• Difficulty swallowing or speaking/voice changes
• Distention or bloating of the abdomen

Possible Complications

Severe cases of subcutaneous emphysema can lead to serious, though rare, complications, such as:

• Respiratory failure
  
• Problems with the airways or heart
• Tension pneumothorax (a collapsed lung)
• Compression of the trachea
• Skin necrosis (death of skin tissues)
• Compartment syndrome (swelling of muscles and other body tissues)
• Poor blood circulation (perfusion) to the brain
• Pacemaker failure
  

Diagnosis

If your doctor suspects you may have subcutaneous emphysema, they may order some of the following tests to aid in the diagnosis:

• X-rays: These may be positive for a "ginkgo leaf sign." This describes an air pattern along the pectoralis major muscle that resembles the veins in a ginkgo leaf.
• Computed tomography (CT): This type of scan can show dark pockets of air in the subcutaneous layer and may also help identify the source of the air.
• Laryngoscopy or bronchoscopy: These procedures may be performed if the condition is thought to result from an injury from intubation.
• Ultrasound: This may be used if a pneumothorax is suspected.

Edema from subcutaneous emphysema has been misdiagnosed as other conditions, such as allergic reactions. However, crepitus and the fact that lip swelling will be absent with subcutaneous emphysema can help medical professionals differentiate between these conditions.

Treatment of Subcutaneous Emphysema

Subcutaneous emphysema usually resolves in about 10 days without serious complications if the underlying cause is successfully treated. During this period, the air pocket is gradually reabsorbed into the body.

In minor cases of subcutaneous emphysema, you might not feel any discomfort. However, it's important to control symptoms and any discomfort you may experience. This can be managed with:

• Oxygen
• Abdominal binders (to compress the abdomen)
• Pain medications

Treatments for subcutaneous emphysema may include:

• The administration of highly concentrated oxygen, since it helps the body absorb the subcutaneous air more quickly.
• Making two infraclavicular incisions on each side (deep incisions made below the clavicle bone).
• The insertion of a chest tube may also be necessary to remove the air.
• In some cases, small incisions may be made in other parts of the body, or needles or catheters may be used to get rid of excess air.

Severe cases of subcutaneous emphysema may require surgical treatments or the insertion of drains.

Prognosis

Despite potentially deadly complications from subcutaneous emphysema, the prognosis is good.

One study showed that among all grades of severity, the mean hospitalization period of patients with subcutaneous emphysema was 16 days.

Coping With Subcutaneous Emphysema

Sometimes swelling of the face or tissue necrosis can cause changes to your appearance that can be troubling. It is important to remember that these appearance changes will improve or completely resolve in time.

Depending on the underlying cause of your subcutaneous emphysema, you may be coping with other health challenges that can also be distressing. Reach out to family members, friends, and your medical team for help dealing with your illness's emotional aspects.

Your medical team may be able to connect you with resources that can aid in coping and recovery.

Summary

Subcutaneous emphysema is a condition in which air becomes trapped under the subcutaneous layer of the skin. The main symptoms are edema and crepitus. There are many possible causes, including accidental injuries during surgery, injury during the placement of a breathing tube, and certain infections.

Some tests to diagnose the condition include X-rays, CT scans, or bronchoscopy. In most cases, subcutaneous emphysema will resolve on its own in around 10 days once the underlying cause is treated.