Noninfectious subcutaneous emphysema of the upper extremity

Traumatic subcutaneous emphysema of the hand/forearm: A case report

Subcutaneous emphysema is commonly associated with infection caused by gas-producing organisms. In this case report, we describe a rare instance of traumatic subcutaneous emphysema of the hand and forearm caused by a puncture injury to the first web space of the hand. Our objective is to increase awareness of the potential for seemingly minor trauma to cause entrapment of significant air in subcutaneous tissues, thereby decreasing the likelihood that a clinically benign-appearing patient will be started down an unnecessarily aggressive treatment pathway. A 16-year-old, otherwise healthy white female, presented to the pediatric emergency room with an impressive amount of subcutaneous emphysema that developed over a 12-h period after sustaining an accidental laceration to the first web space of her right hand. She appeared nontoxic and had a clinically benign presentation. A comprehensive work-up was performed. She was splinted by the orthopedic surgery resident on call, and was admitted to the Pediatric Intensive Care Unit for overnight monitoring. She received tetanus vaccination and broad-spectrum antibiotics. The patient was discharged 2 days after admittance, with a splint applied to her right hand and forearm. She undertook home-based physical and occupational therapy. She had a pain-free range-of-motion in the right wrist, elbow and shoulder. The swelling in the right hand subsided completely. Although initially alarming, traumatic subcutaneous emphysema in an otherwise healthy patient from minor wounds (as featured in this case) does not necessarily mean one ought to proceed down an aggressive treatment algorithm. Careful evaluation of the patient's history, clinical examination findings, and determination of the Laboratory Risk Indicator for Necrotizing Fasciitis score can help guide physicians in the management of traumatic subcutaneous emphysema and potentially avoid unnecessary and costly interventions.

Benign subcutaneous emphysema treated with hyperbaric oxygen therapy after surgical exploration

Benign subcutaneous emphysema of the upper limb is extremely uncommon. Patients with this condition that involves the limbs usually present with local symptoms, and they are systematically well. We report a case of 18-year-old male presented after a minor cut wound in the forearm with diffuse subcutaneous emphysema. The patient was treated with hyperbaric oxygen therapy after wound exploration. Recovery was uneventful. Infectious etiology by gas-forming organisms should be ruled out before considering other causes.

Benign subcutaneous emphysema: a rare and challenging entity a case report and review of the literature

We report the case of a craftsman who developed a rapidly progressive subcutaneous emphysema of his forearm after a minor stab injury into the palm of his hand. Based on our case report we discuss differential diagnosis and management of acute subcutaneous emphysema.

Air in the Breast: A Rare Cause of Iatrogenic Pneumomastia

Air in the breast tissue (pneumomastia) is a rare finding, more so without any history of procedures on the breast. We report the case of an 80-year-old lady who was found to have foci of gas in her right breast on a CT scan. On exclusion of other possible causes for the same, it was concluded that the air in the breast tissue was secondary to a peripheral intravenous line placement. To our knowledge, this is the first reported case of pneumomastia as a complication of peripheral intravenous line placement.