Subcutaneous Emphysema: Common Causes & Symptoms

Emphysema is one disease that falls under the blanket term of COPD, along with chronic bronchitis and reactive airway disease.

With emphysema, patients experience damage to the air sacs (alveoli) in the lungs, causing symptoms such as shortness of breath, wheezing, and persistent coughing. However, there are several types of emphysema, including a subcutaneous form in which patients experience air trapped underneath the subcutaneous space of their skin.

Today, Carda is here to talk about subcutaneous emphysema, including common causes, symptoms, and treatment options. Read on to learn more about supporting pulmonary recovery and overall wellness with Carda.

What Is Subcutaneous Emphysema?

Your skin has several layers, including the outer "epidermis" layer, the middle "dermis" layer, and the "subcutaneous" bottom layer. Subcutaneous emphysema is a medical condition that occurs when air becomes trapped underneath the bottommost layer of skin.

"Emphysema" refers to swelling or expansion from air, which occurs as the air trapped under the subcutaneous skin causes the area to inflate or swell. Most often, the air travels to the neck, upper chest, or face but can travel anywhere in the body to cause skin inflation and swelling.

Also known as crepitus, crepitus of the chest, subcutaneous air, surgical emphysema, or tissue emphysema, subcutaneous emphysema is a rare medical condition. The easiest way to diagnose this form of emphysema is by skin palpation — when you feel the affected area, you will hear a crackling noise, also known as crepitus, as you push on the air through the patient's subcutaneous tissues.

What Causes Subcutaneous Emphysema?

There are several causes of subcutaneous emphysema, including certain medical procedures, injuries, accidents, or infections.

Medical Procedures

Sometimes, medical procedures can trigger subcutaneous emphysema, particularly if the procedure involves a tube insertion in the body.

Procedures that are risk factors for subcutaneous emphysema include:

  • Endoscopy, during which a tube goes through the mouth to reach the esophagus and stomach
  • Bronchoscopy, when a tube goes through the mouth to reach the bronchial tubes
  • Endotracheal intubation, when a tube goes down the throat and trachea to reach the airway

Injury

Different injuries can also cause subcutaneous emphysema, particularly injuries that involve a rupture or tear in the lungs or in the tracheobronchial tree of airway passages that connect to the lung tissue.

Other injuries that are risk factors for subcutaneous emphysema include:

  • Injuries that involve a rupture or tear in the gastrointestinal or esophageal tracts
  • A collapsed lung (pneumothorax), which occurs when air leaks into the pleural space in the thoracic cavity. This can happen spontaneously or from a forceful injury such as a rib fracture
  • A puncture or perforation injury to the chest wall, sinus cavity, or bowel
  • A fracture in a facial bone

Accidents

Accidents that involve blunt or penetrating trauma, such as a gunshot or a broken rib, may lead to subcutaneous emphysema. A scuba diving incidence, particularly when a diver rises to the surface too quickly, may also lead to subcutaneous emphysema. The rapid change in pressure can affect oxygen flow and intake, which can affect lung function.

Other accidents that are risk factors for subcutaneous emphysema include:

  • Corrosives or chemical burns to the esophageal airway
  • Inhaling cocaine
  • A high-pressure injection
  • Dental extraction procedures
  • A gunshot or stab wound

Infections

An infection that involves the bacterium Clostridial myonecrosis is a risk factor for subcutaneous emphysema. With a Clostridial myonecrosis infection, toxins will develop in tissues, cells, and blood vessels, causing body tissue death.

In what is known as gas gangrene, the body tissue death releases gas, which results in subcutaneous emphysema as the released air remains trapped under the skin.

What Are the Warning Signs of Subcutaneous Emphysema?

Symptoms of subcutaneous emphysema can range from nonexistent to severe, depending on the cause and on which part of the body the trapped air affects.

Common symptoms of this medical condition may include swelling or pain in the neck, a sore throat, difficulty breathing or speaking, and wheezing.

Swelling or Pain in the Neck

The most common warning sign for subcutaneous emphysema is swelling, also known as edema, in the affected area. The area with edema is easy to detect because post-palpatory crepitus, or a crackling sound upon palpation, is a key indicator for subcutaneous emphysema.

Swelling normally localizes to the neck because air typically travels upwards and experiences little resistance under the subcutaneous neck skin.

With swelling in the neck, patients can experience pain and soreness and may find it difficult to turn their heads from side to side.

Sore Throat

Subcutaneous emphysema can cause a sore throat if the swelling occurs in the throat or neck. Swelling in these areas may make it difficult to talk and can bring pain and erythema that can subsequently cause tenderness or soreness to present.

Difficulty Breathing or Speaking

Swelling in the throat or neck area can additionally make it difficult to speak due to the increased volume of skin area. The throat pain and soreness can also place a strain on one’s vocal cords, making it painful or simply exhausting to talk or make noises.

Additionally, when the trapped air expands and takes up space around the lungs, patients can experience difficulty breathing as the air presses inward on the lungs. This shortness of breath can become life-threatening quickly — the air can press inward so much on the lungs that they collapse and cause respiratory failure.

Wheezing

When swelling occurs in airway passages, subcutaneous emphysema can cause airway blockages, which can, in turn, cause wheezing as the patient strains to inhale and exhale enough air.

How Can Subcutaneous Emphysema Be Treated?

The level of treatment for subcutaneous emphysema depends on how dangerous the underlying cause is and how uncomfortable the symptoms are for the patient experiencing the condition.

With a mild case of subcutaneous emphysema, no treatment or interventions are necessary, as the body can resorb small amounts of air over time. However, it is still important for healthcare providers to closely monitor the signs and symptoms in case they persist or worsen.

Methods to monitor subcutaneous emphysema symptoms include:

  • Recording areas and sizes of swelling to watch for changes
  • Blood tests
  • A computed tomography (CT scan) of the area with subcutaneous air
  • An ECG
  • A chest X-ray (or for any other affected area)

If swelling persists past 10 days or worsens during any time period, however, more treatment may be needed.

With more severe subcutaneous emphysema cases, treatment may warrant skin incisions and catheter or tube insertions in order to relieve the trapped air and pressure buildup. Additionally, there are interventions that can help relieve the discomfort, including:

  • Supplemental oxygen for breathing support
  • Tracheal intubation for airway support
  • A chest tube if there is a pneumothorax or air leak
  • IV fluids
  • Medications to treat symptoms, or bronchodilators to help expand airways and relieve airway pressure

Pulmonary and Cardiac Rehab

If subcutaneous emphysema causes difficulties breathing, the difficulties can affect the patient’s lung and heart function as oxygen and blood flow diminish.

A pulmonary and cardiac rehabilitation program is another treatment option to help relieve symptoms of subcutaneous emphysema and to foster awareness and management practices for the condition's progression.

Rehabilitation works to improve a patient’s cardiovascular and pulmonary health through interventions like monitored exercise, dietary guidance, and education. These interventions help to facilitate better heart and lung health as well as overall wellness, which research has shown helps reduce hospital readmission or future complications.

If you are looking to refer your patients to life-saving outpatient care and rehab that can help relieve the symptoms of their subcutaneous emphysema, Carda is here to help.

Carda offers at-home personalized virtual rehabilitation programs, which have many benefits and conveniences that traditional in-person rehab facilities cannot provide. With personalized care, all the tools your patients need, and live monitoring, Carda at-home rehabilitation, and care is easier, cheaper, and more effective than in-person rehab.

The Bottom Line

Subcutaneous emphysema is a form of emphysema that involves air trapped under the bottom-most subcutaneous layer of skin.

This medical condition is rare and is often caused by injuries or accidents, medical procedure complications, or infections. When a medical procedure causes the condition, it is known as surgical emphysema, and when an accident or injury is the cause, then it is known as spontaneous subcutaneous emphysema.

Interventions to treat subcutaneous emphysema include close monitoring and medical testing, supplemental airway and breathing support (via intubation or mechanical ventilation) to help relieve pressure and air buildup, or medications to relieve symptoms.

If you are looking for life-saving rehabilitation and care to help manage subcutaneous emphysema symptoms, Carda is here to help. Get started today and take our free assessment to get paired with an expert physiologist.

Sources:

Subcutaneous and Mediastinal Emphysema: Pathophysiology, Diagnosis, and Management | JAMA Internal Medicine

Subcutaneous Emphysema | NCBI | Pubmed

Subcutaneous emphysema | MedlinePlus Medical Encyclopedia

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