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Subcutaneous emphysema

Definition

Subcutaneous emphysema occurs when air gets into tissues under the skin. This usually occurs in the skin covering the chest wall or neck, but can also occur in other parts of the body.

Alternative Names

Crepitus; Subcutaneous air; Tissue emphysema

Considerations

Subcutaneous emphysema can often be seen as a smooth bulging of the skin. When a health care provider feels (palpates) the skin, it produces an unusual crackling sensation as the gas is pushed through the tissue.

Causes

This is a rare condition. When it does occur, possible causes include:

  • Collapsed lung (pneumothorax), often occurring with a rib fracture
  • Facial bone fracture
  • Ruptured bronchial tube
  • Ruptured esophagus

This condition can happen due to:

  • Blunt trauma
  • Breathing in cocaine
  • Corrosives or chemical burns of the esophagus
  • Diving injuries
  • Forceful vomiting (Boerhaave's syndrome)
  • Gunshot wounds
  • Pertussis (whooping cough)
  • Stabbing
  • Certain medical procedures that insert a tube into the body, such as endoscopy (tube into the esophagus the stomach through the mouth), a central venous line (thin catheter into a vein close to the heart), endotracheal intubation (tube into the throat and trachea through the mouth or nose), and bronchoscopy (tube into the bronchial tubes through the mouth).

Air can also be found in between skin layers on the arms and legs or torso after certain infections, including gas gangrene, and after scuba diving.

When to Contact a Medical Professional

Most of the conditions that cause subcutaneous emphysema are very severe, and you are likely already being treated by a doctor. Sometimes a hospital stay is needed, especially if due to an infection.

If you feel subcutaneous air in relation to any of the situations described above, particularly after trauma, call 911 or your local emergency services number immediately.

DO NOT administer any fluids. DO NOT move the person unless it is absolutely necessary to remove them from a hazardous environment. Protect the neck and back from further injury when doing so.

What to Expect at Your Office Visit

The provider will measure and monitor the person's vital signs, including:

  • Temperature
  • Pulse
  • Breathing rate
  • Blood pressure

Symptoms will be treated as appropriate. The person may receive:

  • Breathing support, including oxygen and endotracheal intubation (tube through the nose or mouth into the trachea)
  • Blood tests
  • Chest tube (tube through the skin and muscles between the ribs into the pleural space (lining of the lungs) if there is lung collapse
  • CAT/CTscan (computerized axial tomography or advanced imaging) of the chest and abdomen or area with the subcutaneous air)
  • EKG (electrocardiogram or heart tracing)
  • Fluids (intravenous or through the vein)
  • Medicines to treat symptoms
  • X-rays of chest and abdomen

The prognosis depends on the cause of the subcutaneous emphysema. If associated with major trauma, a procedure or infection, the severity of those conditions will determine the outcome.

Subcutaneous emphysema associated with scuba diving is usually less worrisome or serious.

References

Byvny, RL, Shockley, LW. Scuba Diving and Dysbarism. In: Marx J, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Mosby; 2013:chap 143.

Eckstein M, Henderson SO. Thoracic Trauma. In: Marx J, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Mosby; 2013:chap 45.

Wolfson AB. ed: Harwood-Nuss' Clinical Practice of Emergency Medicine. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2010.


Review Date: 10/18/2014
Reviewed By: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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