Extensive Subcutaneous Emphysema Associated With Pneumothorax, Pneumomediastinum, and Pneumoperitoneum: A Case Report

Subcutaneous emphysema (SE ) is a phenomenon in which air occupies structures under the skin and soft tissues. Common sites for SE include the neck and chest wall, which can extend to other body regions. In this case report, we describe the development of extensive SE, pneumothorax, pneumomediastinum, and pneumoperitoneum in an elderly female following blunt trauma to her right flank. The etiology of SE is broad and includes blunt and penetrating traumas; surgical, infectious, spontaneous causes; or any condition that yields a gradient between intra-alveolar and perivascular interstitial pressures. The incidence of SE has been reported to be 1.4%, while that of spontaneous pneumothorax has been reported to be 0.8% in patients receiving a percutaneous tracheostomy. Conversely, the occurrence of SE, pneumothorax, pneumomediastinum, and pneumoperitoneum in the same patient is rare. The most common signs and symptoms of SE are neck swelling and chest pain. Involvement of the deeper tissues of the thoracic outlet, chest, and abdominal wall often manifests in severe life-threatening conditions. SE can be diagnosed by detecting edema and crepitus of the scalp, neck, thorax, abdomen, and other body regions. Radiograph imaging can confirm the presence of soft-tissue air entry. Extensive SE in the setting of pneumothorax is an unusual entity for which there is, as of now, no consensus in management. Methods of treatment include supportive care, placement of blow holes for evacuation of soft-tissue emphysema, and bilateral infraclavicular incisions. SE is a rare complication that can arise from several etiologies. At the same time, various methods for managing this phenomenon have been mentioned with varying successful outcomes.