Subcutaneous emphysema occurs with traumatic injuries to the lungs, less often to the trachea, esophagus, paranasal sinuses or nose. It can be the result of operations and manipulations. Sometimes it has a non-traumatic etiology. It is manifested by an increase in the volume of a certain area of the body, a characteristic soft crunch on palpation. The cause is established on the basis of anamnesis, examination data, radiography, CT, MRI, endoscopic studies. Treatment includes painkillers and antibacterial agents, punctures, blockades, breathing exercises, and operations.
Traumatic injuries of the chest organs are the most common cause of subcutaneous emphysema. With closed injuries, air penetrates into the subcutaneous tissue due to rupture of the lung. Most often, the integrity of the organ is violated in case of fractures of the ribs with displacement, when sharp bone fragments violate the integrity of the underlying tissues.
Less commonly, lung rupture occurs without concomitant skeletal injury, caused by partial separation of the organ from the root due to a fall from a height or intense horizontal impact, such as a car collision. Against the background of the rupture, a closed pneumothorax develops. With limited pneumothorax, there is little or no subcutaneous accumulation of gas. In victims with a total form of pathology, air can spread through the chest. Sometimes the gas passes from the chest to the neck and face.
Open pneumothorax is observed with stab, stab-cut, less often gunshot wounds of the lung. The severity of emphysema varies greatly. A particularly dangerous form of pathology is valvular pneumothorax - a condition when air enters the pleural cavity when inhaling, but does not leave it when exhaling. Continued injection of gas leads to progressive compression of the lung, mediastinal displacement, and the development of widespread subcutaneous emphysema.
Another possible cause of the symptom is thoracoabdominal trauma. The same mechanism of air release under the skin is observed as with isolated injuries of the chest. Distinctive features are the complex nature of the lesion, the high probability of traumatic shock and life-threatening complications.
Barotrauma of the lungs develops when using scuba gear, rapid ascent to the surface. Due to a sharp increase in pressure in the lungs, the alveoli rupture, air escapes into the tissues with the formation of subcutaneous emphysema in the area of the chest and neck. There are chest pains, shortness of breath, foamy sputum with blood, cyanosis of the skin and mucous membranes. Pneumothorax may occur. There is a risk of cerebral and cardiac embolism.
Subcutaneous emphysema
Fracture of the orbit is accompanied by retraction of the eyeball, soft tissue edema, and periorbital hematomas. Most often, the lower wall of the orbit in the region of the infraorbital foramen suffers. Palpation reveals a sharp pain, a local soft crunch, indicating the presence of subcutaneous emphysema.
Injuries to the paranasal sinuses are manifested by severe local edema, nasal breathing disorders, subcutaneous hemorrhages, aching pain in the area of damage, which increases sharply when palpated. Bloody discharge from the nose is noted. Emphysema is revealed in the affected area. After the edema subsides, an external defect becomes noticeable due to the displacement of the bone wall of the paranasal sinus.
Subcutaneous emphysema is also accompanied by fractures of the bones of the nose with a rupture of the mucosa. Pathology is characterized by sharp pain, sometimes - a crunch at the time of injury. Epistaxis, rapidly increasing edema, which is later supplemented by cyanosis of the nose and lower eyelids, are observed. When the fragments are displaced, a violation of the shape of the nose is revealed.
The cause of emphysema can be perforation of the trachea by a foreign body that accidentally enters the respiratory system (with pranks in children, holding small objects in the mouth in adults). Pathology is manifested by suffocation at the time of aspiration, hoarse paroxysmal cough, combined with lacrimation, vomiting, copious saliva and nasal mucus, cyanosis of the face.
Perforation of the esophagus also occurs due to the ingress of small sharp objects into the organ cavity. When swallowed, the patient feels pain, pressure in the throat and along the esophagus. In case of violation of the integrity of the esophageal wall, acute pains are noted, aggravated by swallowing, subcutaneous accumulation of air, swelling of the soft tissues of the neck. Sometimes a pneumothorax develops.
Minor subcutaneous emphysema can be determined after laparoscopy, localized in the adipose tissue around the punctures. The reason is the injection of carbon dioxide into the abdominal cavity to improve visualization, facilitate the movement of instruments. When injected, a small amount of gas may enter the superficial tissues. The condition does not pose a threat, disappears on its own after a few days.
Bronchial stump failure develops within 1-3 weeks after pulmonectomy, lobectomy or bilobectomy, occurs due to suture failure and, as a result, air enters the pleural cavity, and fluid enters the trachea and bronchi. Accompanied by fever, shortness of breath, pain, cough with a large amount of bloody discharge. Subcutaneous emphysema may be found in the chest, abdomen, face, and neck.
When mechanical ventilation with high inspiratory pressure, patients develop barotrauma. The chest becomes barrel-shaped. The skin turns pale or acquires a cyanotic hue, covered with sweat. Palpation is determined by the "creak", due to the accumulation of air bubbles in the subcutaneous tissue. Possible pneumothorax, pneumomediastinum.
Other pathological conditions associated with subcutaneous emphysema include:
Diagnostic measures are carried out by a pulmonologist. In case of a traumatic genesis of the symptom, the participation of a traumatologist is required; in case of facial lesions, consultation of a maxillofacial surgeon is necessary. During the collection of anamnesis, the specialist finds out what happened in the period preceding the formation of emphysema, identifies other complaints, and evaluates the dynamics of the disease. Carry out the following procedures:
Subcutaneous emphysema on x-ray
Victims with open chest injuries should apply a tight bandage to the wound area to transform an open pneumothorax into a closed one. Rib fractures should be fixed with a wide bandage made of a towel or sheet applied to the chest during exhalation. To facilitate breathing, patients are transported in a semi-sitting position.
Patients with facial injuries carry out bleeding. Cold is applied to the affected area. If the person is conscious, they are transported with their head slightly tilted forward to avoid blood entering the respiratory tract. In case of impaired consciousness, transportation is recommended in the supine position. It is strictly forbidden to set fragments.
Air from adipose tissue resolves on its own, so directly subcutaneous emphysema does not need treatment. Therapeutic measures are aimed at eliminating the cause of the pathology and alleviating the patient's condition. Patients with TG injuries are given anesthesia for fractures or vagosympathetic blockade on admission. According to indications, a pleural puncture is performed to remove air or fluid. The following medications are prescribed:
An obligatory part of the treatment of injuries and diseases of OGK is exercise therapy, which allows you to quickly restore the normal functioning of the bronchi and alveoli. Exercises are performed from the first days after admission. The program is compiled taking into account the patient's condition and the severity of the pain syndrome. Respiratory gymnastics is supplemented with chest massage.
Taking into account the reasons for the development of pathology, the following operations are carried out: