Subcutaneous emphysema of chest wall

Introduction to subcutaneous emphysema in the chest wall Subcutaneous tissue in the chest has a subcutaneous emphysema when the gas volume is present. Subcutaneous emphysema of the chest wall is generally secondary to sternum and/or rib fracture with pneumothorax, especially in patients with multiple rib fractures with tension pneumothorax, but also in tracheal, bronchial, pulmonary and esophageal injuries, occasionally Caused by endoscopic examination of the injury. basic knowledge The proportion of sickness: 0.002% - 0.006% Susceptible people: no special people Mode of infection: non-infectious Complications: heart failure

Causes of subcutaneous emphysema in the chest wall

(1) Causes of the disease

Subcutaneous emphysema of the chest wall is generally secondary to sternum and/or rib fracture with pneumothorax, especially in patients with multiple rib fractures with tension pneumothorax, but also in tracheal, bronchial, pulmonary and esophageal injuries, occasionally Caused by endoscopic examination of the injury.

(two) pathogenesis

Closed and open injuries to the chest are often accompanied by subcutaneous gas accumulation. There are usually three ways in which air can enter the subcutaneous tissue through the damaged site:

1 When the pneumothorax is accompanied by damage to the parietal pleura, the air in the thoracic cavity can enter the subcutaneous tissue of the chest wall through the damaged part.

2 When the trachea, bronchus or esophagus rupture, the air can enter the mediastinum directly from the rupture port, and then spread through the sternum to the neck, face and subcutaneous tissue of the chest.

3 Air directly enters the subcutaneous tissue through the chest wall surface wound.

Chest wall subcutaneous emphysema prevention

Normally, no special treatment is needed for subcutaneous emphysema, but the source of the gas should be controlled in time. In the first aid and surgical treatment of chest trauma, we must pay attention to the dressing and wound dressing and air isolation to prevent pneumothorax.

Chest wall subcutaneous emphysema complications Complications heart failure

When subcutaneous emphysema occurs, the pectoralis major muscles are strained, and the abdominal wall muscles attached to the lower edge of the ribs can cause local bleeding, swelling, chest wall pain, and muscle spasm. The rib transverse joint and the rib joint are connected by a strong ligament, so in the physiological respiratory movement, the rib joint has a very small range of motion. Squeezing or excessively strong sprains can cause tears in the joint ligaments, even rib joints, and compression of the intercostal nerves.

Symptoms of subcutaneous emphysema in the chest wall Common symptoms Sound hoarseness, subcutaneous emphysema, difficulty breathing, chest tightness, post-sternal pain, heart failure, tachycardia, bruises

In general, patients with subcutaneous emphysema have no symptoms, but the effect of a pair of patients is difficult to blink. Patients with mediastinal emphysema often complain of chest tightness or pain in the back of the chest. They may also have hoarseness, swelling of the subcutaneous tissue, and a sponge-like feeling and snoring. And the feeling of snow, if the smell of rough snoring accompanied by heartbeat, as seen in mediastinal emphysema, severe mediastinal emphysema can affect venous return, jugular vein dilation, tachycardia, difficulty breathing, and even heart failure Performance.

Examination of subcutaneous emphysema in the chest wall

X-ray examination shows that the chest wall and/or neck soft tissue has a light-transparent irregular spot shadow. If the left edge of the heart is double-shaded, it is characterized by a large amount of gas accumulation in the mediastinum.

Diagnosis and differentiation of subcutaneous emphysema in chest wall

diagnosis

After chest injury, the skin on the chest wall is swollen. If you touch the sponge and feel the sputum, it indicates that there is subcutaneous emphysema. It is generally not easy to miss the diagnosis or misdiagnosis. Careful clinical observation is helpful to clarify the source of emphysema. In the neck, it should be considered that the source may be mediastinal emphysema, the site of the first emphysema in the chest wall is often the site of rib fracture, X-ray examination helps to further identify the source of emphysema.

Differential diagnosis

Pneumothorax: refers to the gas entering the pleural cavity, resulting in a state of accumulation of gas, called pneumothorax. Usually divided into three categories: spontaneous pneumothorax, traumatic pneumothorax and artificial pneumothorax. Spontaneous pneumothorax is caused by lung disease, rupture of lung tissue and visceral pleura, or due to rupture of tiny vesicles and bullae near the surface of the lungs, air in the lungs and bronchus into the pleural cavity, usually chest X-ray examination Identification.

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