Rapid resolution of severe subcutaneous emphysema with simple percutaneous angiocatheter decompression

Subcutaneous emphysema (SE) is often seen as a sequela of chest tube placement, cardiothoracic surgery, trauma, pneumothorax, infection or malignancy. In most cases SE is self-limited and requires no intervention. Rarely, air can rapidly dissect into subcutaneous tissue planes leading to respiratory distress, patient discomfort and airway compromise. This is a case of a 75-year-old woman that developed massive SE and impending respiratory failure with rapid progression of air into her subcutaneous tissue. In an effort to rapidly stabilize the patient we placed multiple percutaneous angiocatheters into the subfascial space with complete resolution in <24 h. This technique was an excellent temporizing measure and found to be superior to previously described techniques involving large open 'blow hole' incisions or large bore drains. Placement of angiocatheter needles for the decompression of subcutaneous air is a well-tolerated, readily accessibility, low cost and simple procedure for the treatment of SE.