Causes and Management Outcome of Subcutaneous Emphysema in a Busy Thoracic Surgery Unit at Teaching Hospital, Karachi
Keywords:Subcutaneous emphysema, chest tube, barotrauma, blunt chest trauma, penetrating chest trauma
AbstractBackground: Subcutaneous emphysema (SE) is a clinical manifestation of underlying pathology. Identification and addressing those etiologies are therefore important for prevention and management. Objective: To evaluate the causes and management outcome of SE in Thoracic Surgery unit, JPMC, Karachi Methods: A prospective, observational study was conducted from 1st February 2019 till 31st January 2020. Patients aged 12 years or more of either gender were included. Patient’s demographics, clinical information, causes and treatment provided were recorded. Outcome were noted in terms of days required for resolution of SE along with mortality. Results: A total of 155 patients with SE were included. Most common cause was iatrogenic in 58 (37.4%) followed by blunt chest trauma in 44 (28.4%). Secondary spontaneous pneumothorax, penetrating chest trauma, blunt neck trauma, primary spontaneous pneumothorax, and penetrating neck trauma were the other causes. Iatrogenic causes included 21 (36.2%) with chest tube malfunction, 14 (24.1%) secondary to barotrauma. All patients had complete resolution with treatment. Extensive SE observed in 28 (18.1%) patients and was significantly associated with iatrogenic causes (P <0.005). Iatrogenic cases took longer days for clinical resolution (P<0.005) and radiological resolution (P< 0.05). There was no mortality primarily due to SE. Conclusion: Trauma to the lungs and airways secondary to iatrogenic injury is an important preventable cause of SE. Severity of emphysema tend to be extensive among iatrogenic injuries thus taking longer days for resolution. Successful management is possible with high flow oxygen, bronchodilation and meticulous handling of chest tubes.
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