subcutaneous emphysema overview

subcutaneous emphysema is a condition in which air is trapped under the skin. (“Ephysema” simply means “air,” while “subcutaneous” means under the skin.)

This type of emphysema is different from other forms of emphysema, a lung disease often caused by smoking. Subcutaneous emphysema can occur after a medical procedure, surgery, accident, injury, or infection.

This article will explain the symptoms and causes of subcutaneous emphysema, and how to diagnose it. It will also discuss treatment options and coping skills if you are diagnosed with the disorder.


Subcutaneous emphysema is most likely to occur on the chest, neck, and face, but it can occur anywhere on the body and has many different causes. Men are more common than women.

Symptoms of subcutaneous emphysema can range from mild to severe. In fact, it is possible to have no symptoms at all. More severe conditions can cause severe discomfort and serious complications.

Symptoms of subcutaneous emphysema also vary depending on the underlying cause and the part of the body where it is located. However, nearly everyone with subcutaneous emphysema experiences:

  • Edema (swelling) in the affected area
  • CrepitusA crackling sound when the skin surface is palpated (checked by touch)

Crepitus can be a sign that leads a medical professional to diagnose subcutaneous emphysema. This is also why this condition is sometimes referred to simply as thoracic crepitus or crepitus.

Other symptoms may include:

  • sore throat
  • neck pain
  • Difficulty breathing
  • Difficulty swallowing or changes in speech/voice
  • abdominal distention or bloating

Severe cases of subcutaneous emphysema can lead to respiratory failure, a malfunctioning pacemaker, airway or heart problems, or strain pneumothorax (collapsed lung).

Other serious complications may include airway compression, skin necrosis (death of skin tissue), compartment syndrome (swelling of muscles and other body tissues), and poor circulation (perfusion) to the brain.

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The skin is divided into three layers. The outermost layer is called the epidermis; below is the dermis, then the subcutaneous layer, which is mainly composed of fat and connective tissue.

In subcutaneous emphysema, air is trapped under the subcutaneous layer.

Subcutaneous emphysema has many underlying causes, including:

  • Injuries to almost any part of the body, especially the chest, sinuses, or facial bones
  • pneumothorax
  • Infection kills dead bacteria in skin tissue, increasing the risk of gangrene
  • surgical trauma
  • Laparoscopic surgery
  • Barotrauma, also known as a “curve” that can occur in scuba divers. Other activities that expose people to extreme altitude changes can also cause barotrauma.
  • Accidental injury to the trachea during intubation (insertion of a breathing tube)
  • Ventilator malfunction or problem
  • Injury to the esophagus (usually occurs during insertion of a feeding tube)
  • bowel or esophagus perforation
  • Bag-mask ventilation during cardiopulmonary resuscitation (CPR)

In rare cases, subcutaneous emphysema may develop for unknown reasons. This is called spontaneous subcutaneous emphysema.


There are many possible causes of subcutaneous emphysema. These include trauma during surgery, esophagus injury during feeding tube placement, and certain types of bacterial infections. Two symptoms, edema (swelling) and crackling in an area known as crepitus, occur in all cases.


If your doctor suspects that you may have subcutaneous emphysema, they may order some of the following tests to help diagnose:

  • X-rays: These may be positive results for the “Ginkgo Biloba Sign”. This describes an air pattern along the pectoralis major, similar to the veins of a ginkgo biloba.
  • Computed tomography (CT): This type of scan can show dark pockets of air in the subcutaneous layer and may also help identify the source of the air.
  • Laryngoscopy and/or bronchoscopy: These procedures may be performed if the condition is believed to be an injury from intubation.
  • Ultrasound: This test can be used if a pneumothorax is suspected.

Edema due to subcutaneous emphysema has been misdiagnosed as other conditions, such as allergic reactions. However, the presence of crepitus and the fact that there is no lip swelling due to subcutaneous emphysema can help medical professionals differentiate between these conditions.


If the underlying cause is successfully treated, subcutaneous emphysema usually resolves in about 10 days without serious complications. During this time, the air sacs are gradually reabsorbed by the body.

It is also important to manage symptoms and any discomfort. In mild cases of subcutaneous emphysema, you may not experience any discomfort. If you feel uncomfortable, it can be controlled with oxygen, abdominal adhesives (compressing the abdomen), or pain medication.

High concentrations of oxygen are often used as a treatment because it helps the body absorb air under the skin faster.

Severe cases of subcutaneous emphysema may require surgery or insertion of a drain.Another common treatment is to make two subclavian Incisions on each side (these are deep incisions below the collarbone). Sometimes a chest tube will also need to be inserted to expel air. In some cases, small incisions may be made elsewhere in the body, or a needle or catheter may be used to remove excess air.


If your doctor thinks you may have subcutaneous emphysema, they will do diagnostic tests, including X-rays, CT scans, or bronchoscopy. This usually resolves on its own in about 10 days once the underlying cause is known and treated.


Although subcutaneous emphysema can have fatal complications, these complications are actually very rare and have a good prognosis. In one study, patients with subcutaneous emphysema had an average hospital stay of 16 days across all severities.


Mild subcutaneous emphysema may not be troublesome, but in other cases, facial swelling or tissue necrosis can occasionally cause changes in your appearance that can be disturbing. It’s important to remember that these cosmetic changes will improve or resolve completely in time.

Depending on the underlying cause of subcutaneous emphysema, you may be dealing with other potentially distressing health challenges. Connect with family and friends, as well as your healthcare team, to help you deal with the emotional aspects of your illness. Your medical team may be able to connect you with a support group or other resources to help with coping and recovery.


Subcutaneous emphysema is a condition in which air is trapped in the subcutaneous layer of the skin. The main symptoms are edema and crepitus. There are many possible causes, including accidental injury during surgery, injury during placement of a breathing tube, and certain infections. Some tests used to diagnose the condition include X-rays, CT scans, or bronchoscopy. In most cases, subcutaneous emphysema resolves on its own in about 10 days once the underlying cause is treated.

VigorTip words

While subcutaneous emphysema can be uncomfortable and worrying, it can be reassured that in most cases it will go away without any lasting effects. If you notice swelling in an area of ​​your body or a crackling sound when you press on the swollen area, call your healthcare provider as soon as possible.