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Subcutaneous emphysema: an unusual presentation of foreign body in the airway
R Saoji1, C Ramchandra, A J D'Cruz
1Department of Paediatric surgery, St John's Medical College and Hospital, Bangalore, India.
Insights
Foreign bodies in the airway can cause progressive subcutaneous emphysema in children. This unusual presentation is linked to specific anatomical structures and pressure differences allowing air to escape into tissues.
Area of Science:
- Pediatric Pulmonology
- Thoracic Surgery
- Medical Imaging
Background:
- Airway foreign bodies are common in children, often presenting with respiratory distress or cough.
- Subcutaneous emphysema is typically associated with trauma or iatrogenic causes, not commonly with airway foreign bodies.
Purpose of the Study:
- To report an unusual clinical presentation of airway foreign bodies in children.
- To highlight subcutaneous emphysema as a key feature of tracheobronchial foreign bodies.
Main Methods:
- Case series of six pediatric patients with airway foreign bodies.
- Clinical presentation, diagnostic imaging, and management were reviewed.
Main Results:
- All six children presented with progressive subcutaneous emphysema.
- The foreign body was located in the tracheobronchial tree in all cases.
- Anatomical fascial planes and alveolar pressure gradients facilitate air migration.
Conclusions:
- Subcutaneous emphysema should be considered in the differential diagnosis of airway foreign bodies in children.
- This presentation underscores the importance of thorough evaluation for airway foreign bodies in pediatric patients with unexplained subcutaneous emphysema.
Abstract:
Six children with a foreign body in the airway presented with progressive subcutaneous emphysema as a clinical feature. The aim of this report is to highlight this unusual clinical presentation of foreign body in the tracheobronchial tree. A peculiar arrangement of fascial planes in the neck, chest, and abdomen and an excessive pressure gradient at the alveolar level, facilitates extraalveolar migration of air in the subcutaneous tissue.