Unusual subcutaneous emphysema extending to the limbs following blunt chest injury

Subcutaneous emphysema can be traumatic, infectious, iatrogenic, or spontaneous. Traumatic subcutaneous emphysema of the upper limb is not infrequent following trauma to that limb. However, the subcutaneous emphysema of the limbs following trauma to a site other than the limb is seldom reported. A 45-year-old male was referred from a private hospital to a tertiary care hospital with right-sided multiple rib fractures and pneumothorax following chest injury. The patient was having acidotic breathing on examination, and crepitus was present over the bilateral chest and bilateral upper and lower limbs, suggesting subcutaneous emphysema. Right and left intercostal drainage tubes were inserted at our hospital. The patient died in the emergency after a few hours of treatment. The X-ray performed at the autopsy revealed extensive bilateral upper and lower limb subcutaneous emphysema. The deceased had multiple rib fractures over the right side with fractured ends of the two ribs piercing the pleural cavity, causing tears in the lung parenchyma. The cause of death was attributed to the chest injury and its sequelae. Such rapidly expanding subcutaneous emphysema can be a sign of underlying severe chest injury. Prompt insertion of the intercostal drainage tube could be the lifesaving procedure in such cases.