Subcutaneous emphysema from abdominal origin
Postoperative after laparoscopic uterus extirpation, which was carried out in Trendelenburg position (feet higher than head).
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Extensive bilateral subcutaneous emphysema in anterior chest wall and in the neck on the right side. The pectoralis major muscles are outlined by the subcutaneous air on both sides.
Endotracheal tube present. No pneumothorax or other major abnormalities
Although there is extensive subcutaneous emphysema visible throughout this patient's chest x-ray, there is no pneumothorax.
Although the patient was positioned with feet elevated during surgery (Trendelenburg) free subcutaneous air has eventually spread very far cranially. The air was most likely introduced subcutaneously by the laparoscopic instruments.
This case illustrates the importance of clinical information as well as the possibility of subcutaneous emphysema to spread remotely from the site of origin.