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What is subcutaneous emphysema?
Subcutaneous emphysema – this is the accumulation of gas or air bubbles in the tissues, causing the formation of an air cushion. Literally, the term emphysema can be translated as increased airiness. The cause of this disease can be a chest injury, as a result of which the respiratory organs were significantly injured, as well as damage to the esophagus. That is why the air entering the mediastinum compresses large arteries and vessels, which leads to asphyxia, cardiovascular insufficiency and, as a result, death.
The cause of subcutaneous emphysema can also be an external deep wound, during which the respiratory organs were damaged.
In medicine, it is customary to distinguish between several main sources of air entering tissues, namely, only three:
a wound of the chest, which has the property of only letting air into the tissues, but not giving it the opportunity to go back;
in case of damage to the bronchi, trachea or esophagus, when the mediastinal pleura is damaged, so air from the mediastinum freely enters the pleural cavity;
simultaneous violation of the integrity of the parietal pleura and lung, the wound has a valve-like appearance.
When air enters the tissues, it can freely move under the skin from the areolar region to the facial region. Subcutaneous emphysema most often does not cause any disturbances perceptible by patients. In itself, this disease is not dangerous if the cause of its occurrence is identified in time. To find the cause, it is important to follow the dynamics of the development of this process.
Doctors divide all patients into two age categories: young and those who are already over 40 years old. The disease in such people always proceeds in different ways. In young people, aged about 20-30 years, emphysema occurs in a much milder form and with virtually no consequences. In older people, over 40 years old, the disease is much more severe and recovery from the disease takes a little longer.
Causes of subcutaneous emphysema
Doctors distinguish the following reasons, as a result of which subcutaneous emphysema appears:
Chronic bronchitis, smoking. In 90% of cases, it is smoking that causes the development of emphysema. Many patients are mistaken in believing that smoker’s bronchitis is a completely harmless disease. Tobacco smoke contains a large amount of harmful substances that cause destruction of the respiratory tract in the smoker’s body. This leads to heavy changes;
Change in the normal shape of the chest as a result of external influences, trauma;
Serious injuries (closed fracture of the rib, a fragment of which pierced the lung) or chest surgery, laparoscopy;
Anomaly in the development of the organs of the respiratory system, most often these are congenital malformations;
Inhalation of toxic substances that have a destructive effect on the respiratory system (professional activities, polluted environment, work with toxic substances or in hazardous production, builders, etc., people who breathe air containing many harmful impurities);
Gunshot wound, made almost point-blank. Due to the effect of powder gases on the skin around the wound, non-extensive emphysema occurs;
anaerobic infection;
Knife, blunt wounds;
Car crashes in which victims hit their chests against the steering wheel or seats with great force;
Damage to the lungs caused by very strong internal pressure, the so-called barotrauma (jumping into water, a sharp dive to a depth);
With a fracture of the facial bones;
Neoplasms on the neck and in the trachea;
Angina Ludwig;
Perforation of the esophagus. This reason is the most rare;
Sometimes emphysema occurs during dental surgery, due to the peculiarity of the instrument;
Injury to a large joint (knee joint);
With artificial ventilation of the lungs. Use of a tracheal tube.
Symptoms of subcutaneous emphysema
Often the symptoms of subcutaneous emphysema are:
swelling in the neck;
chest pain when breathing;
sore throat, difficulty swallowing;
labored breathing;
swelling of the skin in the absence of obvious traces of its inflammatory process.
You can detect subcutaneous emphysema using an X-ray in the last stages of the disease. As well as simple palpation in the intended area of air accumulation. Under the fingers, the presence of air bubbles under the skin will be very well felt.
When palpated, the patient will not feel any pain or discomfort. When you press on the area of accumulation of gases, a characteristic sound is heard, which is very reminiscent of the crunch of snow. With a significant accumulation of air under the skin, the tissues adjacent to this area swell so much that it becomes noticeable to the naked eye.
If subcutaneous emphysema has formed in the neck, the patient may change his voice and it will be difficult to breathe.
Air can accumulate under the skin in various parts of the body, even on the legs and arms, and the abdomen.
Treatment of subcutaneous emphysema
Emphysema can be diagnosed with an X-ray or CT scan of the chest. As soon as air bubbles are noticed in the tissues of the body, treatment begins immediately. In the early stages of the disease, conservative therapy is carried out, that is, special sprays and aerosols are prescribed. However, they are in no way able to stop the development of the disease.
The course of the disease is carefully monitored by doctors with a certain frequency, and exacerbations of the disease are noted 2 or 3 times a year. During such exacerbations, severe shortness of breath develops. In the third and fourth stages of emphysema, therapeutic treatment has no effect on the disease and the patient has to agree to surgical intervention.
Although in fact, subcutaneous emphysema most often does not require any treatment. By itself, this disease does not pose any danger to the human body, it is only the result of an external injury or some internal organ. And after that it is removed. Air injection under the skin stops. The disease gradually disappears without specialized medical treatment.
How effectively the cause of emphysema has been eliminated is the resorption of air. To speed up the healing process, breathing exercises in the fresh country air are recommended. In this case, the blood is saturated with oxygen, which contributes to the leaching of nitrogen from the body.
Depending on the size of emphysema, a certain surgical intervention is performed, which is aimed at maximizing the elimination of air accumulation.
Emphysema can be dangerous only if it has formed in the chest area and rapidly spreads to the neck, initially under the skin, and then penetrates into the tissues of the neck and mediastinum, which may well cause compression of the internal vital organs. In this case, an urgent operation is necessary, which will help to identify the cause of air injection, as well as eliminate it without serious consequences for the patient.