Introduction
Emphysema is a lung disease that affects the air sacs (alveoli) and causes them to lose their elasticity, making breathing difficult. While both conditions, emphysema and subcutaneous emphysema, share the word "emphysema," they refer to different things and affect different body parts. For example, emphysema primarily affects the lungs, while subcutaneous emphysema affects the tissues under the skin.
What Is Subcutaneous Emphysema?
Subcutaneous emphysema occurs when the air or gas gets trapped in the tissues, typically due to injury or medical procedure. Subcutaneous emphysema is also known as surgical emphysema, tissue emphysema, or subcutaneous air. It is usually present in the neck and chest but may also occur in other body parts. This condition causes smooth bulging over the skin.
Gas entrapped within the tissues will remain in one place itself. Sometimes, it can spread via connective tissues like muscles and ligaments. Research studies suggest that inhaling through the chest can cause the air to reach the shoulders, neck, and face, potentially leading to temporary changes in facial appearance. This condition is more common in men than women.
What Causes Subcutaneous Emphysema?
Subcutaneous emphysema can occur due to various underlying conditions or procedures, which include the following.
1. Trauma: Physical trauma to the body, such as a crush injury, can cause air to escape from the lungs and enter the tissues under the skin.
2. Infections: Infections with certain bacteria that cause gas gangrene. Gangrene is a condition of tissue death caused by the bacteria clostridium perfringens.
3. Surgery: Certain surgical procedures, such as thoracic or head and neck surgery, can release air into the tissues.
4. Medical Procedures: Medical procedures, such as chest tube placement or tracheostomy, can cause subcutaneous emphysema.
5. Lung Disease: Subcutaneous emphysema can be a complication of lung disease, such as chronic obstructive pulmonary disease (COPD) or pneumothorax.
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Chronic obstructive pulmonary disease is a long-lasting lung condition that makes breathing difficult. It is caused by long-term damage to the lungs, usually from smoking,
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Pneumothorax is a medical condition affecting the lungs where air leaks into the area between the chest wall and the lung, causing lung collapse. It can be caused by injury, lung disease, or other underlying conditions.
6. Laparoscopic Surgery or Keyhole Surgery: It is a minimally invasive surgical procedure using a laparoscope (an instrument fitted with light and a camera).
7. Barotrauma: Also known as bends, it is an injury to the body caused by changes in atmospheric pressure and can occur in scuba divers or individuals who perform activities that subject a person to extreme altitude changes.
What Are the Signs and Symptoms of Subcutaneous Emphysema?
The primary symptom of subcutaneous emphysema is the presence of air or gas in the tissues under the skin, which can cause swelling and the sensation of crepitus or crackling sounds when the affected area is touched or compressed. Other symptoms may include:
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Pain: The affected area may be tender or painful to the touch.
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Swelling: The affected area may appear swollen and firm to the touch.
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Changes in Skin Color: The skin may appear bluish or reddish due to decreased oxygenation in the affected area.
How Can Subcutaneous Emphysema Be Diagnosed?
Subcutaneous emphysema can be diagnosed using a combination of physical examination, imaging, and laboratory tests.
1. Physical Examination: During a physical examination, a doctor will examine the affected area for signs of subcutaneous emphysema. This may include a feeling of crepitus (a crackling sensation) under the skin, which is a sign of air or gas pockets. The doctor may also ask the patient to perform a series of movements to see if the crepitus worsens. The skin may be distended, swollen, or discolored in severe cases.
2. Imaging Tests: These tests can also help the doctor determine the extent of the condition and identify any underlying causes. Imaging tests can be used to visualize the presence of air or gas pockets under the skin, which includes:
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X- Rays: The radiograph shows intermittent areas of translucency (allowing light to pass through). A Gingko leaf sign may be seen on the chest radiograph. The presence of air along the pectoralis major muscle gives a resemblance to the ginkgo leaf.
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CT (Computed Tomography) Scan: It shows dark pockets in the subcutaneous layer (deeper layer of skin) due to the presence of gas.
3. Laboratory Tests: Blood tests are performed to rule out other underlying conditions contributing to the subcutaneous emphysema. For example, the doctor may test for bacterial infections or blood clotting disorders.
4. Laryngoscopy or Bronchoscopy: This procedure is done to identify any injury to the trachea (tube-like structure present in the airway system) if this condition occurs during intubation.
How Is Subcutaneous Emphysema Treated?
Treatment for subcutaneous emphysema depends on the underlying cause and the severity of the condition. The air or gas pockets may resolve independently without specific treatment in mild cases. However, in more severe cases, several treatment options may be considered, which include:
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Conservative Treatment: In mild cases of subcutaneous emphysema, bed rest and pain relief medications may be sufficient to manage the symptoms. Oxygen therapy may also improve breathing and provide oxygen to the body's tissues. A chest tube or needle aspiration may sometimes remove air or gas pockets. This can help to relieve pressure and prevent further complications.
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Antibiotic Therapy: If an infection is the underlying cause of subcutaneous emphysema, antibiotics may be prescribed to treat the infection. The specific antibiotic type will depend on the bacteria causing the infection.
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Surgical Treatment: Surgery may be needed to repair the damage if the subcutaneous emphysema occurs due to a lung tear or a ruptured bronchial tube. Thoracotomy (an incision in the chest wall) may be performed to drain the air or gas pockets in severe cases. The surgeon may also repair damaged tissue or remove foreign objects causing the condition during the procedure.
Sometimes, treatment options can be combined to manage subcutaneous emphysema effectively. The specific treatment plan will vary depending on the underlying cause of the subcutaneous emphysema.
Conclusion
The prognosis of subcutaneous emphysema depends on the underlying cause. Subcutaneous emphysema seen during scuba diving is usually non-serious. However, if this condition is associated with major trauma, a procedure, or an infection, the severity of those conditions will affect the treatment outcome. Subcutaneous emphysema may be prevented by avoiding specific procedures or treatments that may cause the illness. Taking measures to maintain lung health and avoid lung disease will help prevent this condition to a certain extent. Consult a healthcare professional as early as possible for accurate diagnosis and appropriate treatment.
