Spot the Pneumothorax.

Area of Science:

• Thoracic Surgery
• Emergency Medicine
• Critical Care

Background:

• Subcutaneous emphysema (SE) and pneumomediastinum are common in trauma patients, often linked to rib fractures.
• Typically, SE does not necessitate urgent intervention or routine drainage procedures.

Observation:

• A critically ill patient presented with SE causing acute upper airway compromise and respiratory distress.
• Standard imaging techniques had limitations in fully assessing the extent of pneumothorax associated with SE.

Findings:

• The case was novel due to SE leading to severe respiratory compromise requiring immediate intervention.
• Urgent bilateral wide-bore subcutaneous drains and thoracic drain insertion were vital for stabilization.

Implications:

• This case underscores the technical challenges in diagnosing SE etiology and the limitations of conventional imaging.
• Highlights the critical role of prompt surgical drainage in managing SE with acute airway compromise, buying time for definitive treatment.