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Subcutaneous emphysema

Crepitus; Subcutaneous air; Tissue emphysema; Surgical emphysema

Subcutaneous emphysema occurs when air gets into tissues under the skin. This most often occurs in the skin covering the chest or neck, but can also occur in other parts of the body.

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Considerations

Subcutaneous emphysema can often be seen as a smooth bulging of the skin. When a health care provider feels (palpates) the skin, it produces an unusual crackling sensation (crepitus) as the gas is pushed through the tissue.

Causes

This is a rare condition. When it does occur, possible causes include:

This condition can happen due to:

Air can also be found in between skin layers on the arms and legs or torso after certain infections, including gas gangrene, or after scuba diving. (Scuba divers with asthma are more likely to have this problem than other scuba divers.)

When to Contact a Medical Professional

Most of the conditions that cause subcutaneous emphysema are severe, and you are likely already being treated by a provider. Sometimes a hospital stay is needed. This is more likely if the problem is due to an infection.

If you feel subcutaneous air in relation to any of the situations described above, particularly after trauma, call 911 or your local emergency services number immediately.

DO NOT administer any fluids. DO NOT move the person unless it is absolutely necessary to remove them from a hazardous environment. Protect the neck and back from further injury when doing so.

What to Expect at Your Office Visit

The provider will measure and monitor the person's vital signs, including:

Symptoms will be treated as needed. The person may receive:

The prognosis depends on the cause of the subcutaneous emphysema. If associated with major trauma, a procedure or infection, the severity of those conditions will determine the outcome.

Subcutaneous emphysema associated with scuba diving is most often less serious.

References

Byyny RL, Shockley LW. Scuba diving and dysbarism. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 135.

Cheng G-S, Varghese TK, Park DR. Pneumomediastinum and mediastinitis. In: Broaddus VC, Mason RJ, Ernst JD, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 6th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 84.

Kosowsky JM, Kimberly HH. Pleural disease. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 67.

Raja AS. Thoracic trauma. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 38.

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Review Date: 7/1/2020  

Reviewed By: Jesse Borke, MD, FACEP, FAAEM, Attending Physician at FDR Medical Services/Millard Fillmore Suburban Hospital, Buffalo, NY. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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