Man with massive subcutaneous emphysema

Subcutaneous emphysema is a well-described and frequently self-limited complication of multiple medical conditions including patients who have undergone the insertion or removal of chest tubes. While typically benign, the extensive collection of soft tissue emphysema in select patients can lead to significant respiratory distress secondary to restricted thoracic wall excursion or laryngotracheal dysfunction due external compression from the subcutaneous gas. In these patients, release of this trapped air via gill-slit incisions of the thoracic wall can be a life-saving intervention. We present the case of a 57-year-old male with a history of a recently removed chest tube who presented with significant respiratory distress and marked dysphonia secondary to severe subcutaneous emphysema who underwent bilateral gill slit incision of his anterior chest with rapid resolution of his symptoms.