Subcutaneous Emphysema

What is subcutaneous emphysema?

Subcutaneous emphysema is when air gets into the deepest layer of your skin (the subcutaneous layer). It’s a rare complication that has many causes, including infections, injuries and surgical traumas.

It’s normal for some air to build up under your skin after certain procedures, like laparoscopic surgery. But this accumulation of air often clears up on its own, and it usually doesn’t cause any noticeable symptoms. In some cases, however, subcutaneous emphysema could be an indication of an underlying health condition.

Subcutaneous emphysema is most likely to affect your face, neck or chest — but it can happen anywhere on your body.

Subcutaneous emphysema is rare, affecting just over 2% of the general population. According to one research study, the average age of diagnosis was 53 — and about 70% of those people were male.

What are the symptoms of subcutaneous emphysema?

The two most common symptoms of subcutaneous emphysema are:

1. Skin swelling (edema) in the affected area
2. Crepitus (a crackling sound that happens when you press on your skin in the affected area)

Other subcutaneous emphysema symptoms may include:

• Trouble breathing
• Difficulty swallowing (dysphagia)
• Sore throat
• Neck pain
• Gas (bloating)

What causes subcutaneous emphysema?

Subcutaneous emphysema causes include:

• Barotrauma, which can occur when there’s a sudden shift in air or water pressure (common in scuba divers)
• Collapsed lung (pneumothorax), which happens when excess air in your chest cavity creates pressure against your lung, causing it to collapse
• Infections, especially those with flesh-eating bacteria (like necrotizing fasciitis)
• Injuries, especially those that affect your chest, face or sinuses
• Medical or surgical traumas, like accidental injuries from equipment issues or placing medical devices

Specific medical situations that could result in subcutaneous emphysema include:

• Bag-mask ventilation during CPR
• Feeding tube insertion
• Holes in your digestive tract (gastrointestinal perforations)
• Intubation (Intubation is when your healthcare provider places a tube into your windpipe to keep your airway open)
• Mechanical ventilation malfunction

In rare cases, subcutaneous emphysema can happen for no known reason.

What are the complications of subcutaneous emphysema?

Severe cases of subcutaneous emphysema can result in complications like:

• Collapsed lung (pneumothorax)
• Compartment syndrome
• Pacemaker failure
• Poor blood circulation to your brain
• Respiratory issues
• Tracheal compression (when something presses on and narrows your windpipe)

If an infection causes subcutaneous emphysema, it can cause serious (and sometimes life-threatening) complications, including:

• Acute respiratory distress syndrome (ARDS)
• Coma (persistent vegetative state)
• Delirium
• Kidney failure
• Necrosis (tissue death)
• Sepsis

How is subcutaneous emphysema diagnosed?

Your healthcare provider will need to run some tests to find out if you have subcutaneous emphysema. These tests could include:

• Bronchoscopy to identify issues affecting your lungs or airways
• CT (computed tomography) scan, an imaging test that uses X-rays and a computer to create detailed images of bones and tissues
• Ultrasound, which uses high-intensity sound waves to capture images inside your body
• X-rays, which uses radiation to take two-dimensional images of your bones and tissues

The type of test you need depends on which area of your body has swelling and what your provider thinks caused your symptoms.

How is subcutaneous emphysema treated?

Subcutaneous emphysema treatment involves addressing the underlying cause. Once your provider begins treatment, your symptoms should go away in about 10 to 14 days.

Healthcare providers treat mild cases of subcutaneous emphysema with oxygen concentrators. These devices allow you to breathe up to 95% pure oxygen and help your body reabsorb the air trapped under your skin.

To release excess trapped air, your provider may also need to:

• Insert a chest tube (thoracostomy)
• Make two incisions below each clavicle bone
• Use needles, catheters (hollow tubes) or incisions to remove air in other parts of your body

Severe cases of subcutaneous emphysema may require surgery. Or your provider might place drains to remove excess air.

How can I ease my discomfort?

Subcutaneous emphysema doesn’t always cause painful symptoms. But if you develop discomfort, your healthcare provider may give you:

• Pain medications (analgesics)
• An abdominal binder (a compression garment to wear around your belly)
• Concentrated oxygen

How long does it take to recover from subcutaneous emphysema?

Most people recover in about 10 to 14 days after receiving treatment. In one research study, the average length of recovery — even in severe cases — was 16 days.

Can subcutaneous emphysema be prevented?

Subcutaneous emphysema usually occurs in situations that are out of your control. There’s nothing you can do to keep it from happening — and you haven’t done anything wrong. If you develop symptoms, the best thing to do is call your healthcare provider right away. They can determine whether you need treatment and, if so, what kind.

What’s the outlook for subcutaneous emphysema?

The outlook is positive with treatment. But time is of the essence. The sooner you see your healthcare provider, the sooner you can ease your symptoms and reduce your risk of serious complications.

How long does subcutaneous emphysema last?

With treatment, most people with subcutaneous emphysema recover in about two weeks.

When should I see my healthcare provider?

Call your healthcare provider immediately if you develop any of the following:

• Unexplained swelling in your skin
• Crackling sounds when you press on the affected skin
• Bloating in your belly
• Difficulty breathing or swallowing
• Neck pain or sore throat

What questions should I ask my doctor?

If you have subcutaneous emphysema, here are some questions you may want to ask your healthcare provider:

• What caused my condition?
• Will it go away on its own?
• Do I need treatment? If so, what kind?
• Will I need to stay in the hospital?
• When can I return to work or school?

Is subcutaneous emphysema an emergency?

Subcutaneous emphysema isn’t always an emergency — but prompt treatment is key, no matter your situation. Many people with the condition only experience mild symptoms. But some people have serious complications. If you notice worrisome symptoms — like bulging or crackling sounds when you press on your skin — you should visit your healthcare provider right away.