Pacemaker malfunction due to subcutaneous emphysema--a case report

[Massive subcutaneous emphysema--management using subcutaneous drains]

Massive subcutaneous emphysema is a relatively common complication in invasive techniques, surgical practice and some medical conditions. Subcutaneous emphysema is usually treated conservatively and may only cause minimal symptoms. Even when it is severe, subcutaneous emphysema rarely has pathophysiologic consequences, but it is extremely uncomfortable for the patient. The authors report a case of massive and rapid developing subcutaneous emphysema following chest tube displacement in a patient with spontaneous se- condary pneumothorax and large air leak. The emphysema was treated with two subcutaneous drains, inserted using local anesthesia, on both sides of the chest (antero -superior thoracic wall), connected to drainage bags. The drains produced a dramatic clinical improvement and provided effective decompression of the subcutaneous emphysema. In this clinical case, the technique of drainage of severe subcutaneous emphysema using subcutaneous drains was safe, easy and effective, affording immediate symptom relief.

Simple construction of a subcutaneous catheter for treatment of severe subcutaneous emphysema

Subcutaneous emphysema often presents a management dilemma. Rarely, subcutaneous emphysema has pathophysiologic consequences. More often, it is extremely uncomfortable for the patient, and is often disfiguring and alarming for patients and family. When subcutaneous emphysema is severe, physicians may feel compelled to treat it, but the currently described techniques are often invasive or ineffective. We describe the use of an easily constructed, minimally invasive, fenestrated catheter that relieves the symptoms of subcutaneous emphysema.

Failure of unipolar pacemaker secondary to subcutaneous emphysema

Failure of a pacemaker to capture may be related to several factors. This report describes a case with loss of capture of a unipolar pacemaker following the development of subcutaneous emphysema. Once the diagnosis is established, treatment options include tube thoracostomy, pressure dressing, aspiration of air or fluid from the pocket, or insertion at a new site.

Cardiac pacemaker dysfunction in children after thoracic drainage catheter manipulation

Two children underwent placement of permanent, epicardial-lead, dual-chamber, unipolar pacemaker systems for complete heart block. Postoperatively, both patients demonstrated subcutaneous emphysema-in the area of their pulse generators-temporally related to thoracic catheter manipulation. Acutely, each situation was managed with manual compression of the pulse generator, ascertaining appropriate pacemaker sensing and pacing. Maintenance of compression with pressure dressings, vigilant observation/monitoring, and education of the care givers resulted in satisfactory pacemaker function without invasive intervention.