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Unilateral subcutaneous emphysema after percutaneous tracheostomy
1Department of Anesthesiology, Toronto Western Hospital, Ontario M5T 2S8, Canada.
Canadian Journal of Anaesthesia = Journal Canadien D'Anesthesie
|December 6, 2005
Summary
Subcutaneous emphysema is a rare complication of percutaneous tracheostomy. This case highlights an unusual presentation without significant tracheobronchial injury, suggesting air trapping due to a snug tracheostomy tube fit.
Area of Science:
- Critical Care Medicine
- Surgical Complications
- Respiratory System
Background:
- Percutaneous tracheostomy is a common procedure in intensive care units.
- Subcutaneous emphysema is a known, albeit rare, complication.
- This report details an atypical case of subcutaneous emphysema post-percutaneous tracheostomy.
Observation:
- A 39-year-old male developed right-sided neck subcutaneous emphysema after percutaneous tracheostomy.
- Fever and neck swelling mimicked deep soft tissue infection, necessitating surgical exploration.
- No direct injury to the tracheobronchial tree was identified during exploration.
Findings:
- Subcutaneous emphysema can occur after percutaneous tracheostomy without evident tracheobronchial injury.
- A snug fit of the tracheostomy tube may impede air escape, leading to cervical emphysema.
- Asymmetric tracheal dilatation might contribute to unilateral subcutaneous emphysema localization.
Implications:
- Clinicians should consider subcutaneous emphysema in the differential diagnosis of neck swelling post-percutaneous tracheostomy.
- This case expands understanding of the potential mechanisms of subcutaneous emphysema.
- Further investigation into the relationship between tracheostomy tube fit and emphysema development is warranted.