Subcutaneous emphysema, strictly speaking, refers to air in the subcutaneous tissues. But the term is generally used to describe any soft tissue emphysema of the body wall or limbs, since the air often dissects into the deeper soft tissue and musculature along fascial planes.
Clinically it is felt as crepitus and, if extensive, may cause soft tissue swelling and discomfort. Even when severe subcutaneous emphysema is typically benign, although complications such as airway compromise, respiratory failure, pacemaker malfunction and tension phenomena have been described.
Causes of subcutaneous emphysema can be divided into:
- gas arising internally
- gas introduced externally
- penetrating trauma
- post-percutaneous intervention, e.g. pleural drain insertion
- gas produced de novo
- gas producing infection(s), e.g necrotising fasciitis
Subcutaneous emphysema is readily visible on CT scans, with pockets of air seen as extremely dark low (air) attenuation areas in the subcutaneous space.
Treatment and prognosis
Treatment is directed at the underlying cause, while the subcutaneous air is absorbed by the body over time. Symptomatic management should also be provided.
However in rare instances where the subcutaneous air is compromising overlying soft tissue or causing a compartment syndrome management may involve release of the air by surgical division of the soft tissues or percutaneous drain insertion.
- 1. Beck PL, Heitman SJ, Mody CH. Simple construction of a subcutaneous catheter for treatment of severe subcutaneous emphysema. Chest. 2002;121 (2): 647-9. doi:10.1378/chest.121.2.647 - Pubmed citation
- 2. Chimutengwende-Gordon M, Khan WS, Sidhu J et-al. Advanced trauma life support radiographic trauma series: part 2-the chest radiograph. J Perioper Pract. 2011;20 (12): 430-5. Pubmed citation
- 3. Adam A, Dixon AK, Gillard J et-al. Grainger & Allison's Diagnostic Radiology: Expert Consult: Online and Print. Churchill Livingstone. ISBN:B00K8G3JYK. Read it at Google Books - Find it at Amazon