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Subcutaneous emphysema

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.

Pathology

Causes of subcutaneous emphysema can be divided into :

  • air introduced externally : e.g.
    • penetrating trauma
    • surgery
    • percutaneous intervention
  • air produced de novo : e.g.

Clinical presentation

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.

Treatment and prognosis

Treatment is directed at the underlying cause, while the subcutaneous air is absorbed over time.

However in rare instances management may involve release of the air by surgical division of the soft tissues or insertion of catheters.

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