Subcutaneous emphysema refers to the presence of air or gas inside skin tissue layers. The condition usually occurs when air escapes the lungs or airways through a tear or puncture. A person may notice swelling in the neck and chest and palpable bubbles that make a cracking noise when they are pressed. In most cases, subcutaneous emphysema itself is not painful nor does it cause major complications. The underlying cause is typically the major concern for doctors, and treating it quickly is necessary to prevent severe cardiac or respiratory problems.
Many different illnesses and injuries can result in subcutaneous emphysema. Many cases are caused by trauma to the chest or neck. A gunshot, knife wound, or blunt force from a fall or car accident can all damage the lungs or trachea. Severe lung infections, chronic diseases, and cancers may weaken lung tissue linings and lead to lung collapse. Occasionally, a botched surgery or an improperly placed chest tube can cause air leakage into the chest cavity as well.
Subcutaneous emphysema caused by penetrating or blunt trauma is usually not the main concern of health professionals. The condition may not be noticed or addressed until lifesaving measures have been taken to stop bleeding or re-inflate a damaged lung. After a patient is stable, doctors can look for signs of emphysema.
The most common symptoms include light swelling, chest and neck pain, and difficulty breathing. Crackling bubbles can usually be felt, moved around, and broken apart underneath the skin. Chest x-rays and computerized tomography scans may be taken to determine the amount and exact location of air pockets.
Most cases of subcutaneous emphysema do not need to be treated directly. Air bubbles tend to dissipate on their own over a few hours as long as problems with the lungs and airways have already been corrected. If a small amount of air persists, a doctor may choose to make several small, deep incisions into the skin to allow gas to escape. Catheters may be used to draw large quantities of air from the chest cavity and surrounding skin tissue.
Additional treatment may be needed if there is enough remaining air to put excess pressure on the trachea or lungs. A chest tube can be inserted to suction out the chest cavity. A patient may need to wear an oxygen mask or receive a breathing tube while subsequent repairs are made to the lungs and airways.