Surgical emphysema complicating chest drain

Case contributed by Dr Varun Babu

Presentation

Road traffic accident with respiratory distress. Chest drain was inserted following detection of pneumothorax in the ER sonogram.

Patient Data

Age: 30 years old
Gender: Male

ER radiograph post chest drain insertion

Modality: X-ray

Chest drain in situ in left hemithorax. No pneumothorax. Patient with no clinical respiratory distress. 

Radiograph after 24 hours

Modality: X-ray

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. 

3 hours post tube repositioning

Modality: X-ray

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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Case Information

rID: 45885
Case created: 12th Jun 2016
Last edited: 12th Jun 2016
Inclusion in quiz mode: Included

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