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Saela S, Decilveo A, Isaac R, Patel DV. Traumatic subcutaneous emphysema of the hand/forearm: A case report. Chin J Traumatol 2022; 25:395-399. [PMID: 35450804 PMCID: PMC9751530 DOI: 10.1016/j.cjtee.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/18/2022] [Accepted: 03/23/2022] [Indexed: 02/04/2023] Open
Abstract
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.
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Affiliation(s)
- Stephen Saela
- Department of Orthopaedic Surgery, St. Josephs University Medical Center, Paterson, NJ 07503, USA,Corresponding author.
| | - Alexander Decilveo
- Department of Orthopaedic Surgery, St. Josephs University Medical Center, Paterson, NJ 07503, USA
| | - Roman Isaac
- Department of Orthopaedic Surgery, St. Josephs University Medical Center, Paterson, NJ 07503, USA
| | - Deepak V. Patel
- Department of Orthopaedic Surgery, St. Josephs University Medical Center, Paterson, NJ 07503, USA,Department of Orthopaedic Surgery, Seton Hall University, South Orange, NJ 07079, USA
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Prange T. Noninfectious causes of subcutaneous emphysema. EQUINE VET EDUC 2020. [DOI: 10.1111/eve.13061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- T. Prange
- North Carolina State University Raleigh North Carolina USA
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De Roeck L, Van Assche L, Verhoeven V, Vrints I, Van Thielen J, Tondu T, Thiessen F. Progressive subcutaneous emphysema of unknown origin: a surgical dilemma. Acta Chir Belg 2019; 119:251-253. [PMID: 29475402 DOI: 10.1080/00015458.2018.1438560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objective: Subcutaneous emphysema can be an alarming sign of a necrotizing soft tissue infection. However, non-infectious etiologies exist that can be treated conservatively. This case report describes a subcutaneous emphysema of unknown origin and highlights the importance of distinguishing these clinical entities. Methods: We present a 17-year old female with pain and subcutaneous emphysema of the left arm. There were no systemic symptoms. Inflammatory parameters were slightly elevated. Computed tomography (CT) scan of the chest excluded intrathoracic abnormalities. Despite antibiotic treatment, the pain increased and the emphysema extended. Necrotizing fasciitis was feared. A surgical exploration was performed and hyperbaric oxygen therapy was started. Results: Intraoperatively, puncture marks were identified on the left arm. Air noticeably escaped, but normal, unaffected tissues were identified and microbiological cultures remained negative. We observed a good clinical evolution. Conclusion: The lack of apparent causes, the unexplained puncture marks and psychiatric comorbidity suggests the possibility of subcutaneous emphysema due to factitious manipulations. Patients with subcutaneous emphysema who remain clinically stable, have minimal pain and no significant inflammatory changes could be treated conservatively. Close clinical monitoring is essential to avoid delayed intervention in case of a necrotizing soft tissue infection.
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Affiliation(s)
- Lynn De Roeck
- Department of Plastic, Reconstructive and Aesthetic Surgery, ZNA Middelheim Hospital, Antwerp, Belgium
| | - Lauranne Van Assche
- Department of Plastic, Reconstructive and Aesthetic Surgery, ZNA Middelheim Hospital, Antwerp, Belgium
| | - Veronique Verhoeven
- Department of Plastic, Reconstructive and Aesthetic Surgery, ZNA Middelheim Hospital, Antwerp, Belgium
| | - Ina Vrints
- Department of Plastic, Reconstructive and Aesthetic Surgery, ZNA Middelheim Hospital, Antwerp, Belgium
| | - Jana Van Thielen
- Department of Plastic, Reconstructive and Aesthetic Surgery, ZNA Middelheim Hospital, Antwerp, Belgium
| | - Thierry Tondu
- Department of Plastic, Reconstructive and Aesthetic Surgery, ZNA Middelheim Hospital, Antwerp, Belgium
| | - Filip Thiessen
- Department of Plastic, Reconstructive and Aesthetic Surgery, ZNA Middelheim Hospital, Antwerp, Belgium
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Garofalo S, Aidala E, Teruzzi E, Pace Napoleone C, Carbonaro G, Cerrina A, De Filippi C, Schleef J. Massive Retro-Pneumoperitoneum and Lower Limb Subcutaneous Emphysema After Pediatric Heart Transplantation: A Case Report. Transplant Proc 2016; 47:2176-8. [PMID: 26361672 DOI: 10.1016/j.transproceed.2014.11.076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 11/19/2014] [Indexed: 11/25/2022]
Abstract
An emphysema in a lower limb is usually a clinical sign of a severe and life-threatening infection. We report a rare case of subcutaneous emphysema of the left lower limb associated with a massive retro-pneumoperitoneum and pneumatosis intestinalis after cardiac transplantation in a 4-year-old girl. The child was nearly asymptomatic beside an abdominal distension. A benign pneumoperitoneum associated with an extensive pneumatosis intestinalis is a rare complication after organ transplantation and should be treated conservatively. The association with an emphysema in a lower limb in a child has not been previously reported to our knowledge in the literature.
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Affiliation(s)
- S Garofalo
- Clinic of General Pediatric Surgery, Children's Hospital "Regina Margher ita," "Città della Salute e della Scienza," Turin, Italy.
| | - E Aidala
- Clinic of Pediatric Cardiac Surgery, Children's Hospital "Regina Margherita," "Città della Salute e della Scienza," Turin, Italy
| | - E Teruzzi
- Clinic of General Pediatric Surgery, Children's Hospital "Regina Margher ita," "Città della Salute e della Scienza," Turin, Italy
| | - C Pace Napoleone
- Clinic of Pediatric Cardiac Surgery, Children's Hospital "Regina Margherita," "Città della Salute e della Scienza," Turin, Italy
| | - G Carbonaro
- Clinic of General Pediatric Surgery, Children's Hospital "Regina Margher ita," "Città della Salute e della Scienza," Turin, Italy
| | - A Cerrina
- Clinic of General Pediatric Surgery, Children's Hospital "Regina Margher ita," "Città della Salute e della Scienza," Turin, Italy
| | - C De Filippi
- Imaging and Diagnostics, Children's Hospital "Meyer," Florence, Italy
| | - J Schleef
- Clinic of General Pediatric Surgery, Children's Hospital "Regina Margher ita," "Città della Salute e della Scienza," Turin, Italy
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Ture P, Kurdi M, Shaikh S, Kallapur B. An unusual case of subcutaneous emphysema without pneumothorax following brachial plexus block. J Anaesthesiol Clin Pharmacol 2016; 32:117-8. [PMID: 27006558 PMCID: PMC4784193 DOI: 10.4103/0970-9185.175718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Pushpavathi Ture
- Department of Anaesthesiology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - Madhuri Kurdi
- Department of Anaesthesiology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - Safiya Shaikh
- Department of Anaesthesiology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - Basavaraj Kallapur
- Department of Anaesthesiology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
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Mack JA, Woo SL, Haase SC. Noninfectious subcutaneous emphysema of the upper extremity. J Hand Surg Am 2015; 40:1233-6. [PMID: 25910589 DOI: 10.1016/j.jhsa.2015.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 03/02/2015] [Accepted: 03/05/2015] [Indexed: 02/02/2023]
Affiliation(s)
- Jacob A Mack
- University of Michigan Medical School, Ann Arbor, MI
| | - Shoshana L Woo
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI
| | - Steven C Haase
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI.
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