Subcutaneous Emphysema Case Study
Abstract
Pneumomediastinum (PM) with pneumopericardium and subcutaneous emphysema is an uncommon finding following blunt trauma. Traumatic Pneumomediastinum occurs in 10% of cases of blunt trauma to chest. Most of the cases are due to alveolar rupture and leak of air from the pneumothorax, rest are due to Macklin effect. CT scan is the primary imaging modality to detect pneumomediasinum at an earlier stage that can be life threatening. We present here a case of 45 years old male with alleged history of road traffic accident with fracture first rib who developed pneumomediastinum, pneumopericardium and subcutaneous emphysema due to Macklin effect without associated pneumothorax which resolved spontaneously on conservative management.
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The majority of traumatic PM results from medial tracking of air from a concomitant pneumothorax. The Macklin effect, of air tracking medially along peribronchial sheaths from alveolar rupture, is responsible for most other cases. 4 When there is fracture of ribs the cause for pneumomediastinum is usually due to tracking of air from pneumothorax. Pneumomediastinum and pneumopericardium due to Macklin effect without pneumothorax in a case of fracture first rib following blunt chest trauma is …show more content…
On examination was found to have crepitus over chest and neck. Chest X ray revealed oblique fracture of left 1st rib with minimal displacement and linear radiolucent areas of air streaks noted in soft tissue neck, pulmonary hilar and left scapular region (Fig1a,b). CT scan was performed immediately. Non-enhanced Axial Sections of CT Neck/Thorax mediastinal window showed presence of air in the mediastinum with extension to neck (Fig2a,b). Non-enhanced Axial Sections of CT thorax lung window showed streaks of air surrounding vessels of neck, thyroid, trachea, oesophagus and ascending aorta with extension of air into pericardium(Fig 3,4) .The patient was put under close observation with symptomatic treatment in ICU for two weeks. After close monitoring for 2 weeks CT Thorax lung showed spontaneous complete resolution of pneumomediastinum, pneumopericardium and subcutaneous emphysema.(Fig
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