Subcutaneous emphysema

Subcutaneous emphysema (or less correctly surgical emphysema), strictly speaking, refers to gas in the subcutaneous tissues. But the term is generally used to describe any soft tissue emphysema of the body wall or limbs since the gas often dissects into the deeper soft tissues 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.

In the trauma situation, the gas often does not need treatment itself, but its importance lies in the fact that its presence indicates possible serious injuries that do require urgent management. Gas can track along fascial planes and enter the head, neck, limbs, chest, abdomen, and scrotum.

Causes of subcutaneous emphysema can be divided into:

Trauma is the most common cause seen 5.

There are often striated lucencies in the soft tissues that may outline muscle fibers. If affecting the anterior chest wall, subcutaneous emphysema can outline the pectoralis major muscle, giving rise to the ginkgo leaf sign 2. Often there are displaced rib fractures indicating a cause of the gas.

Subcutaneous emphysema is readily visible on CT scans, with pockets of gas seen as extremely dark low (air) attenuation areas in the subcutaneous space.

Treatment is directed at the underlying cause, while the subcutaneous gas is absorbed by the body over time. Symptomatic management should also be provided.

However, in rare instances where the subcutaneous gas is compromising overlying soft tissue or causing a compartment syndrome management may involve the release of the gas by surgical division of the soft tissues or percutaneous drain insertion.

  • gas trapped in skin folds or clothing
  • gas within soft tissue lacerations
  • gas associated with long hair
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Article information

rID: 4038
System: Chest, Trauma
Synonyms or Alternate Spellings:
  • Surgical emphysema

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  • Case 10: with pneumomedistinum
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  • Case 11: with multiple other pathology
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  • Case 13: involving the scrotum
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