Presentation
Road traffic accident with respiratory distress. Chest drain was inserted following detection of pneumothorax in the ER sonogram.
Patient Data
Chest drain in situ in left hemithorax. No pneumothorax. Patient with no clinical respiratory distress.
Clinically poor maintenance of saturation. Radiograph reveals a hypertranslucent left hemithorax with absent lung markings. Lung collapsed and folded medially with air fluid level in the left costophrenic angle. Thin rim of air seen along the lateral margin of the aortic knuckle and pulmonary bay.
Significant newly developed subcutaneous edema involving left chest wall and extending superiorly into the left supraclavicular soft tissue planes.
Following repositioning, there is re expansion of the left lung with near total resolution of pneumothorax. Surgical emphysema persists.
Case Discussion
Subcutaneous emphysema is a known complication of chest drains. Clinically it presents with extreme discomfort, anxiety or upper airway obstruction.
It is known to occur with prolonged drainage, tube blockage, side port migration or poor tube placement. Incidence is more when multiple drains are in place.
Usually self limiting and managed conservatively.
Rarely intervention may be required and multiple techniques like infraclavicular blow holes, subcutaneous pig tail or large bore drains may be tried.
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