BACKGROUND: Subcutaneous emphysema refers to swelling caused by the presence of air or gas in the interstices of loose connective tissue. In the head and neck area, it may follow the fascial planes and is characterized by sudden swelling, crepitus on palpation, infrequent pain, and air emboli on radiography. It usually occurs as a complication in dental treatment. Some reports have described subcutaneous emphysema caused by dental procedures; however, severe emphysema related to peri-implantitis after treatment has not been documented. Accordingly, the current report describes a rare case of subcutaneous cervical emphysema resulting from the use of an air-powder abrasive device to treat peri-implantitis. CASE PRESENTATION: Based on a review of the existing literature and the present case, nine cases of subcutaneous emphysema due to air-powder abrasive device have been reported. In most cases, the emphysema resolved over time after treatment with prophylactic antibiotics; among these, two were related to peri-implantitis management. CONCLUSION: Considering the frequent use of air-powder abrasive devices to treat peri-implantitis, the potential risk of iatrogenic emphysema related to this procedure needs to be addressed more extensively.
Anti-Bacterial Agents ; Connective Tissue ; Emphysema ; Head ; Mediastinal Emphysema ; Neck ; Palpation ; Peri-Implantitis ; Radiography ; Subcutaneous Emphysema

We report a case of extensive subcutaneous emphysema of the lower extremity mimicking gas gangrene following perforation of the rectum in a 38-yr-old man. Subcutaneous emphysema of the leg may rarely occur secondary to perforation of the gastrointestinal tract and has often created serious diagnostic problems and high mortality rates. Therefore, prompt diagnosis and aggressive treatment is imperative.
Adult ; Diagnosis, Differential ; Gas Gangrene/*radiography ; Humans ; Intestinal Perforation/*radiography ; Male ; Rectal Diseases/*radiography ; Subcutaneous Emphysema/*radiography

PURPOSE: To evaluate the clinical presentations, radiological characteristics, and natural history of healthy adolescents presenting with idiopathic spontaneous pneumomediastinum. MATERIALS AND METHODS: We retrospectively reviewed the simple radiographs of 14 consecutive patients (11 males) with spontaneous pneumomediastinum, who were examined over a period of 8 years, and analyzed their clinical history, radiographic findings including distribution, combined subcutaneous emphysema, mediastinal widening, pneumothorax, pleural effusion, and resolving period on follow up chest radiographs. We also obtained CT images of 7 patients for the assessment of additional information. RESULTS:The most common complaint at the time of presentation was chest pain and chest discomfort (8/14), followed by neck discomfort (6/14). The chest radiograph was of diagnostic value in all cases. The main distribution of the pneumomediastinum was cervical (14/14), upper lung (13/14) and lower lung (6/14). Combined subcutaneous emphysema was observed in 6 patients. However, there were no cases of mediastinal widening, pneumothorax or pleural effusion. Complete resolution of the pneumomediastinum on the radiograph was observed after 10 days (mean 5.6), following purely conservative treatment. There was no additional information on the CT images, as compared with that on the radiographs. Conclusions: Idiopathic spontaneous pneumomediastinum is a benign entity that usually goes undiagnosed, but which responds very well to conservative treatment.
Adolescent ; Chest Pain ; Emphysema ; Follow-Up Studies ; Humans ; Lung ; Mediastinal Emphysema* ; Natural History ; Neck ; Pleural Effusion ; Pneumothorax ; Radiography, Thoracic ; Retrospective Studies ; Subcutaneous Emphysema ; Thorax

Spinal epidural emphysema is rare, and only a few cases have ever been reported. A 18 year-old man was admitted for neck and chest pain for 3 days. Before admission he experienced rhinorrhea and severe cough. Physical examination revealed wheezing on whole lung field and subcutaneous emphysema over the upper portion of the chest and neck. Chest radiograph showed pneumomediastinum ajdn subcutaneous emphysema in the neck and chest CT images demonstrate a free air in the prevertebral fascia. With coservative management, the patient's condition and the pneumomediastinum improved. The patient was discharged to home on the fourteenth day.
Asthma* ; Chest Pain ; Cough ; Emphysema* ; Fascia ; Humans ; Lung ; Mediastinal Emphysema ; Neck ; Physical Examination ; Radiography, Thoracic ; Respiratory Sounds ; Subcutaneous Emphysema ; Thorax ; Tomography, X-Ray Computed

A 30-year-old primipara at 41 weeks gestation was admitted with regular labor pain and delivered a healthy male infant without complications except for a 4th degree tear of perineum. Two hours after delivery, she complained of sore throat and developed mild swelling of left side face, neck and upper chest. A chest radiography showed mild subcutaneous emphysema of neck. There was no pneumomediastinum and pneumothorax. She was managed conservatively and discharged without any complication at the 6th postpartum day. We report a rare case of subcutaneous emphysema with a brief review of literatures that presented shortly after vaginal delivery without complications except for a 4th degree perineal tear and resolved without special treatment.
Adult ; Female ; Humans ; Infant ; Labor Pain ; Male ; Mediastinal Emphysema ; Neck ; Obstetric Labor Complications ; Perineum ; Pharyngitis ; Pneumothorax ; Postpartum Period ; Pregnancy ; Radiography ; Subcutaneous Emphysema* ; Thorax ; Vacuum*

Mediastinal emphysema (pneumomediastinum) may result from lung disease, trauma, surgery, diagnostic or therapeutic procedure, but spontaneous occurrence is rare. Patients presenting with chest pain, radiating pain to neck and back, cough, dyspnea, dysphagia and demonstrate air-shadow line on left cardiac border by chest radiography. The authors' case is presented of pneumomediastinum, with subcutaneous emphysema occurring three days postoperatively, in a 12-year-old male patient who underwent bilateral vesico-urethral reimplantation under general anesthesia. The patient was treated conservatively with oxygen and had an uneventful recovery. The authors discuss the possible causes and its management with a review of the relevant literature.
Anesthesia, General* ; Chest Pain ; Child ; Cough ; Deglutition Disorders ; Dyspnea ; Humans ; Lung Diseases ; Male ; Mediastinal Emphysema* ; Neck ; Oxygen ; Radiography ; Replantation* ; Subcutaneous Emphysema* ; Thorax

Percutaneous dilatational tracheostomy (PDT) has become an increasingly popular method of establishing an airway for patients in need of chronic ventilator assistance. We report a rare case of a 42-year-old female who developed extensive subcutaneous emphysema, bilateral pneumothoraces, pneumomediastinum, and pneumoperitoneum after percutaneous dilatational tracheostomy. The patient suffered from amyotrophic lateral sclerosis, and underwent PDT after a period of mechanical ventilation. During PDT, tracheostomy tube was inserted into the paratracheal space. Follow-up chest radiography and computed tomography of chest and abdomen revealed extensive subcutaneous emphysema, bilateral pneumothoraces, pneumomediastinum, and pneumoperitoneum. The patient was treated successfully with insertion of the thoracostomy tube and conservative care.
Abdomen ; Adult ; Amyotrophic Lateral Sclerosis ; Female ; Follow-Up Studies ; Humans ; Mediastinal Emphysema ; Methods ; Pneumoperitoneum ; Radiography ; Respiration, Artificial ; Subcutaneous Emphysema ; Thoracostomy ; Thorax ; Tracheostomy* ; Ventilators, Mechanical

We experienced one case of bilateral pneumothorax developed after total thyroidectomy with modified radical neck dissection in a 44-year-old male patient with thyroid carcinoma. After the conclusion of the operation, the patient was extubated after confirming recovery of consciousness and spontaneous respiration. Soon after the extubation, sudden-onset dyspnea with desaturation was developed. Rapid re-intubation was performed. Bilateral pneumothorax with severe subcutaneous emphysema was recognized on chest radiograph and successfully treated by chest tube insertion. Secondary operation was performed and tracheal injury was proved to be the source of the pneumothorax. The patient was discharged uneventfully 14 days later.
Adult ; Chest Tubes ; Consciousness ; Dyspnea ; Humans ; Male ; Neck Dissection* ; Pneumothorax* ; Radiography, Thoracic ; Respiration ; Subcutaneous Emphysema ; Thyroid Neoplasms ; Thyroidectomy*

BACKGROUND: Spontaneous pneumomediastinum is an uncommon, benign, self-limited disorders that usually occurs in young adults without any apparent precipitating factors or disease. The purpose of this study was to review our experience in dealing with this entity and describe a reasonable course of assessment and management. MATERIAL AND METHOD: A retrospective case series was conducted to identify adults patients with SPM who were diagnosed and treated in a single institution between 2001 and 2005. RESULT: Fifteen patients were identified who included 14 men and 1 women with a mean age of 26 years. Presenting symptoms were chest pain in 12 patients (80%), dyspnea in 5 patients (33%), and throat discomfort in 4 patients (26%). Two cases were associated with use of inhalational drugs and 3 cases were associated with exercise. The predisposing factors were asthma, excessive exercise, and vomiting in spontaneous pneumomediastinum. The physical findings were subcutaneous emphysema in 10 patients (77%). Chest radiography and computerized tomography were the diagnostic methods in all cases with CT scan revealing six cases with associated pulmonary abnormalities. Esophagogram and flexible bronchoscopy were selectively used. Fifteen patients (100%) were admitted to the hospital. Their mean hospital stay was 3 days. All patients were conservatively treated. In a follow-up of 3 years no complications or recurrences were observed. CONCLUSION: Most simple spontaneous pneumomediastinum cases were benign diseases and most of them (77%) had shown typical chest pain, dyspnea and subcutaneous emphysema. Inhalational drug use was not a major cause of SPM; however, increased use of bronchoinhalers was a suspicious cause of SPM.
Adult ; Asthma ; Bronchoscopy ; Causality ; Chest Pain ; Dyspnea ; Female ; Follow-Up Studies ; Humans ; Length of Stay ; Male ; Mediastinal Emphysema* ; Mediastinum ; Pharynx ; Precipitating Factors ; Radiography ; Recurrence ; Retrospective Studies ; Subcutaneous Emphysema ; Thorax ; Tomography, X-Ray Computed ; Vomiting ; Young Adult

Pneumomediastinum and subcutaneous emphysema generally occurs following trauma to the esophagus or lung. It also occurs spontaneously in such situations of elevating intra- thoracic pressure as asthma, excessive coughing or forceful straining. We report here on the rare case of a man who experienced the signs of pneumomediastinum and subcutaneous emphysema after a prolonged bout of intractable hiccup as the initial presenting symptoms of multiple sclerosis.
Adult ; Brain/pathology ; Hiccup/*complications/etiology ; Humans ; Magnetic Resonance Imaging ; Male ; Mediastinal Emphysema/*etiology/radiography ; Multiple Sclerosis/*complications/diagnosis ; Subcutaneous Emphysema/etiology ; Thoracic Vertebrae/pathology ; Tomography, X-Ray Computed