About subcutaneous emphysema

subcutaneous emphysema

Subcutaneous emphysema

[What kind of illness] 

Injured chest, air leaked from damaged lungs and trachea

Subcutaneous emphysema accumulates in the subcutaneous tissue.

If the trachea or bronchus ruptures, it will be located between the left and right lungs (mediastinum).

Leaked air collects. This is called mediastinal emphysema.

[Symptom]

In the case of subcutaneous emphysema, air accumulates in the chest and neck, and it swells.

It hurts strongly. When you touch it, it feels crispy like snow.

In addition to chest pain and dyspnea, mediastinal emphysema presents with a variety of symptoms.

Either way, it's life-threatening. It is necessary to bring it to the emergency hospital as soon as possible.

[Treatment of Subcutaneous emphysema]

If the degree is light, thoracic drainage (chest chew in the thoracic cavity)

-Insert the tube and remove the accumulated air), and if you are at rest, it will take 2 to 3 weeks.

It will heal. If chest tube drainage does not work, open the chest and suture the damaged area.

I need surgery to do it.

Subcutaneous emphysema, mediastinal emphysema

[Lung structure]

There is one human lung on each side of the heart.
The center of the medial side of the lung is called the hilar, which connects the hilum to the bronchi, pulmonary arteries, pulmonary veins, bronchial veins, lymph vessels, and nerves.
The right lung consists of the upper lobe, middle lobe, and lower lobe, and the left lung is divided into the upper lobe and lower lobe.
In the lung lobe, polygonal lobules are gathered, and the lobar bronchus branches in it spread over a certain lung area and further divides into alveoli (a bag at the tip of the airway, which is a place for gas exchange).

The thin membrane that directly protects the lungs is called the pleura, which bends in the lung department and has two serosas on the inner wall of the thoracic cavity (the space between the lungs, the chest wall, and the diaphragm, where the pleural effusion collects). A small amount of serosa is secreted between these two thin membranes, and when the lungs expand or contract, the chest wall (the part that looks like the wall from the skin to the pleura) consists of ribs and fascia. The friction of the part) is prevented.

The midline of the thoracic cavity is sandwiched between the left and right lungs, and the part between the left and right lungs where the heart, esophagus, trachea, and large blood vessels leading to the heart are located is called the "mediastinum."

(1) Subcutaneous emphysema

① What is subcutaneous emphysema?

Subcutaneous emphysema is a condition in which air accumulates in the subcutaneous tissue.
The routes of air invasion include external invasion due to skin damage, invasion of intrathoracic air (pneumothorax) through the damaged parietal pleura, and the mediastinum due to period / bronchial injury and esophageal injury.

② Cause

Trauma that causes traffic accidents is especially bruising of the chest, falling from a high place, and barotrauma caused by being pinched, resulting in fractures of the ribs and sternum and damage to the lungs, trachea, bronchi, and esophagus. I have an onset.

③ Symptomatology

Air builds up in the chest and neck, causing the area to swell and cause severe pain.

When you touch the bulging part, you will feel the feeling of gripping the snow (feeling of snow) and the sound of popping and popping air (sound of twisting hair).

You may also complain of chest pain and dyspnea.

④ Diagnosis

A definitive diagnosis is often made by chest XP and CT examination.

Diagnosis is also possible from physical findings (feeling of gripping snow, popping sound of air popping).

If you have difficulty breathing, a blood test (pulse oximeter reading (SpO2)) will confirm it.

※Pulse Oximeter

A pulse oximeter is attached to the fingertip to measure the proportion of hemoglobin in the blood that is bound to oxygen, and the measured value is called SpO2.

⑤ Treatment

Mild subcutaneous emphysema can be cured in a few days or after a few weeks of rest unless the air leaks persist. Follow-up while using cough medicine and painkillers.

In the case of progressive and widespread subcutaneous emphysema, a needle or tube may be inserted to temporarily remove the subcutaneous air from the skin (exhaust).

(2) Mediastinal emphysema

① What is mediastinal emphysema?

Mediastinal emphysema is a type of subcutaneous emphysema, in which air leaks to the area (mediastinum) between the left and right lungs in the center of the chest.

② Cause

It can occur if a traffic accident causes blunt damage to the trachea or bronchi of the chest. It is also possible that the ribs break and stick into the alveoli.

③ Symptomatology

Mediastinal emphysema cannot be observed externally, but chest trauma can cause chest pain, dyspnea, cyanosis, subcutaneous emphysema, and bloody sputum.

④ Diagnosis

In mediastinal emphysema, the causative trachea / bronchial rupture and esophageal perforation/rupture are investigated.

A diagnosis will be made as a result of chest XP, CT, and blood tests.

⑤ Treatment

If medical treatment does not improve, suture the injured area.

(3) About residual disability grade

Under the name of subcutaneous emphysema or mediastinal emphysema, there are not many serious cases that leave respiratory disorders.

If you have respiratory problems, prove it by the test method described in "Pulmonary Contusion".

① Chest XP, CT examination

② Spirometry test

③ Arterial blood oxygen partial pressure / arterial carbon dioxide partial pressure

④ Cardiopulmonary exercise test (CPET)

Mediastinal emphysema caused by tracheal/bronchial rupture or esophageal perforation/rupture must be demonstrated by a different approach.

Specifically, we will explain tracheal/bronchial rupture and esophageal perforation/rupture.

Asia Total Law Office accepts consultations and requests not only from Fukuoka but also from Kyushu and all over Japan, so please feel free to contact us.

Our office receives about 200 consultations about traffic accidents and aftereffects annually.

Most of them are from Fukuoka prefecture, but there are also consultants from outside the prefecture.

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