ICU Chest Films > Air in the Chest > Subcutaneous Emphysema

Subcutaneous Emphysema

Subcutaneous emphysema from air dissecting through fascial planes is a benign condition which resolves spontaneously. Subcutaneous emphysema usually occurs due to an air leak from the lung into the chest cavity and out into the subcutaneous tissues. It may also result from poorly positioned chest tubes or a non-occlusive dressing around a thoracostomy site. In the absence of pneumomediastinum, patients with cervical subcutaneous emphysema should be examined for upper airway injury, especially following a difficult intubation or the placement of a new nasogastric tube.

In the supine, intubated patient the first sign of barotrauma is often subcutaneous emphysema.
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The radiographic appearance of subcutaneous emphysema may be striking. Air dissecting between muscle bundles in the pectoralis region is often apparent. Unfortunately, this compromises the x-ray study because subcutaneous air can mimic infiltrates or obscure underlying parenchymal disease. Detecting a pneumothorax also can become difficult in the presence of subcutaneous emphysema.

Subcutaneous emphysema seen in the soft tissues over the right chest, making the diagnosis of pneumothorax (arrows) more difficult.