Subcutaneous Emphysema

Subcutaneous Emphysema



Basic Information image



Definition


Accumulation of air in the subcutaneous tissues of the skin



Risk Factors




• Endoscopic surgery


• Intramuscular injections


• Choke


• Pulmonary disease


• Animal bites


• Axillary or pectoral wounds


• Trauma to the sinuses, trachea, larynx, or thorax



Associated Conditions and Disorders




• Pneumothorax


• Pneumomediastinum


• Pneumoretroperitoneum



Clinical Presentation



History, Chief Complaint




• History of recent surgery


• History of choke or nasogastric intubation


• History of trauma resulting in wounds on the head, neck, or thorax


• Recent therapy with intramuscular injections


• Suspected or observed snakebite


• Dyspnea


• Abnormal swelling


• Lameness



Physical Exam Findings




• Horses may be anxious, dyspneic, tachypneic, or colicky.


• Palpation of subcutaneous swelling may identify crackles.


• Emphysema may be painful to palpation (may be indicative of infectious origin).



Etiology and Pathophysiology




• Infectious causes of emphysema are related to the accumulation of gas produced by anaerobic bacteria (clostridial species most commonly).


• Iatrogenic causes include surgical incisions, transtracheal wash procedures, and escape and accumulation of air related to endoscopic insufflation.


• Respiratory causes of emphysema include disruptions of any portion of the pulmonary system (sinuses, larynx, trachea, lungs, mediastinum), resulting in a communication to the subcutaneous space.


• Traumatic wounds into the subcutaneous space may result in an accumulation of air because of a valvelike action of the wound opening (axillary wounds, esophageal rupture).



Diagnosis image



Differential Diagnosis




• Infectious


image Intramuscular injection

image Esophageal rupture

image Severe pneumonia, pulmonary bullae rupture

• Iatrogenic


image Surgery

image Laryngotomy incisions

image Transtracheal wash

• Traumatic


image Tracheal rupture (necrosis) (Figure 1)

image Skull fractures involving the sinuses

image Pectoral and axillary wounds

image Thoracic inlet wounds

image Esophageal rupture

image Bite wounds (snake, dog, other horses)

image Rib fractures penetrating the lung

image

FIGURE 1 A and B, A mare with subcutaneous emphysema caused by traumatic tracheal rupture. A, Note the distended supraorbital fossae and severe swelling of the face, chest, and shoulders. B, Off right frontal view to better demonstrate chest and shoulder swelling.


(Courtesy Dr. Nelson Pinto.)

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Jul 24, 2016 | Posted by in SMALL ANIMAL | Comments Off on Subcutaneous Emphysema

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