Extensive subcutaneous emphysema following lobectomy

Area of Science:

• Thoracic Surgery
• Pulmonary Medicine
• Medical Imaging

Background:

• Subcutaneous emphysema is a rare but serious complication following thoracic surgery.
• Early recognition and management are essential to prevent further complications.

Observation:

• A 65-year-old male presented with severe swelling post-left upper lobectomy, initially misdiagnosed as an allergic reaction.
• Physical examination revealed widespread subcutaneous emphysema from the face to the mid-torso.
• Computed tomography (CT) scan identified a pleuro-cutaneous fistula and pneumothorax.

Findings:

• The patient developed extensive subcutaneous emphysema secondary to a pleuro-cutaneous fistula at the chest drain site.
• A Seldinger chest drain was successfully inserted after two attempts.
• The case underscores the diagnostic challenges and management difficulties associated with left-sided intercostal drains in patients with subcutaneous emphysema.

Implications:

• This case highlights the importance of considering subcutaneous emphysema in the differential diagnosis of post-thoracic surgery swelling.
• It emphasizes the need for careful chest drain placement and monitoring to prevent fistulas.
• Effective management requires a multidisciplinary approach involving thoracic surgeons and radiologists.