A 9-year-old boy presented with the history of dog bite over the front of neck followed by diffuse swelling of face, neck and chest wall twelve hours prior to admission. On examination bite marks were seen over the front of neck with extensive subcutaneous emphysema of the face, neck, chest wall, abdominal wall, right scrotum and right upper limb (Fig. 1). Systemic examination was normal. X-ray neck and chest showed extensive subcutaneous air (Fig. 2). The child was given rabies vaccine and 400 IU of human rabies immunoglobulin was infiltrated around the wound. Surgical exploration revealed a lacerated wound in the trachea requiring tracheostomy. Subcutaneous emphysema was decompressed by two stab incision in the submandibular region. The swelling of the face, neck and chest wall decreased gradually, and had resolved completely in six days.

Fig.1. Photograph showing swelling of face, neck and chest wall due to subcutaneous emphysema.

Fig. 2. X-ray showing subcutaneous air in the neck, axilla and supra clavicular region.

Subcutaneous emphysema indicates a break in the integrity of the airway at some point between the pharynx and terminal bronchiole. Air trapped under the skin gives rise to a characteristic crackling sensation on palpation. Subcutaneous emphysema most commonly occurs as a result of pneumo-mediastinum or pneumothorax, but can also follow perforating injury to larynx or trachea. Sometimes it may be a complication of asthma or thoracocentesis. If the cases of the air leak is from respiratory system, no specific treatment is required and resolution occurs by resorp-tion of subcutaneous air. Rarely dangerous compression of trachea by air in the surrounding soft tissue requires surgical intervention.

A.M. Vijayalakshmi,
M. Thinakar Vel,
PSG Institute of Medical Sciences
and Research, Peelamedu,
Coimbatore 641 004, Tamilnadu, India.
E-mail: [email protected]