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Copyright of Revista de la Asociación Colombiana de Dermatología y Cirugía Dermatológica is the property of Asociacion Colombiana de Dermatologia y Cirugia Dermatologica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

To retrieve, analyze, and extract evidence related to subcutaneous emphysema in patients undergoing laparoscopic surgery systematically, and provide evidence-based recommendations for reducing its incidence. By browsing the websites of the National Institute for Health and Clinical Excellence, the International Guideline Collaboration Network, the National Guideline Library of the United States, the Registered Nurses Association of Ontario, the Scottish Intercollegiate Guideline Network, the Clinical Practice Guidelines website of the Canadian Medical Association, UpToDate, Web of Science, PubMed, OVID, Cochrane Library, Embase, Chinese Biomedical Database, CNKI, VIP, and Wanfang Database, relevant literatures, guidelines, systematic reviews, evidence summaries, expert consensus, randomized controlled trials, etc. about subcutaneous emphysema in patients undergoing laparoscopic surgery were retrieved. All searches were limited to articles published between 1st January 2010 to 1st August 2023. 2245 articles were identified in total, 10 articles were included after exclude literature that does not meet the standards, including 3 clinical decision-making articles, 2 review papers, and 5 randomized controlled trials. Evidence summarization was conducted from 5 aspects: influencing factors, prevention, establishment and management of pneumoperitoneum, intraoperative monitoring, and intervention methods, 15 pieces of best evidences were summarized. Clinical staffs should transform and apply the evidence-based practices to decrease the incidence of subcutaneous emphysema and enhance the quality of life for patients. [ABSTRACT FROM AUTHOR]

This retrospective case study aimed to evaluate the efficacy of collagen matrix (DuraGen®) in preventing subcutaneous emphysema, a common complication following dorsal rhinotomy. Six client-owned dogs diagnosed with nasal masses using computed tomography were included in this study. Dorsal rhinotomy was performed, and a collagen matrix was used to seal bone defects before fixation of the nasal bone flap. Following collagen matrix application, all dogs recovered without notable complications. These findings suggest that the collagen matrix is a reliable and safe intervention for mitigating subcutaneous emphysema after dorsal rhinotomy. [ABSTRACT FROM AUTHOR]

Given the paucity of data on pediatric spontaneous pneumomediastinum (SPM), management is largely informed by extrapolation from adult studies or personal clinical experience, resulting in significant heterogeneity. The purpose of this study was to describe how pediatric patients with SPM are clinically managed at our institution and propose a treatment algorithm. Retrospective chart review of pediatric patients with SPM from April 2002 to December 2021 at a single Canadian tertiary care center. Data on medical history, presentation characteristics, clinical management, and complications were gathered. Descriptive and inferential statistics were used to analyze data. We identified 63 patients for inclusion, median age was 15 years. Twenty-nine patients were transferred from another facility. Most common presenting symptoms were chest pain (72.3%), shortness of breath (44.6%), and subcutaneous emphysema (21.5%). Initial workup included chest x-ray (93.6%), CT scan (20.6%), and upper GI series (7.9%). There was no difference in the number of initial tests between admitted and discharged patients (p = 0.10). Of admitted patients (n = 35), 31.4% had primary SPM (no underlying comorbidity/inciting event) and 68.8% were secondary SPM (underlying comorbidity/inciting event). No patients with primary SPM developed complications or recurrences. In contrast, 16.7% of those with secondary SPM developed complications and 54.2% had at least one additional intervention after admission. There is significant variability in diagnostic investigation and treatment of pediatric SPM at our center. Amongst primary SPM, additional tests did not change complication rate or recurrence, including those transferred from another facility. An expeditious treatment algorithm is warranted. Retrospective Cohort Study. III. [ABSTRACT FROM AUTHOR]

Air leak syndrome (ALS) is described in human medicine as a constellation of clinical disorders including pneumomediastinum, pneumopericardium, pulmonary interstitial emphysema, pneumothorax, pneumoperitoneum, pneumoretroperitoneum and subcutaneous emphysema. The pathogenesis of ALS depends on the anatomy of the mediastinum and its associations with thoracic, abdominal and cervical connective tissues, as well as a physical phenomenon referred to as the Macklin effect. Various animal species develop diverse combinations of these lesions, although ALS has not been recognized in animals. However, this term aids pathologists in addressing this disease compilation. The aim of this retrospective study is to illustrate examples of ALS in animals by arbitrarily selecting 13 cases in dogs, cats, pinnipeds, sea otters and harbour porpoises. ALS can be classified into three groups based on aetiology: iatrogenic, secondary or spontaneous. Iatrogenic ALS was diagnosed in two cats with tracheal laceration following endotracheal intubation. Secondary ALS was identified in two dogs, one with acute respiratory distress syndrome and the other due to grass awn migration. Secondary ALS in pinnipeds was diagnosed following severe pulmonary parasitism, uraemic pneumonia and oesophageal perforation. The other marine mammals developed ALS following trauma. Spontaneous ALS was also diagnosed in one cat and one dog without any apparent predisposing causes. [ABSTRACT FROM AUTHOR]

Copyright of Revista Española de Cirugía Oral y Maxilofacial is the property of Sociedad Espanola de Cirugia Oral y Maxilofacial (SECOM) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Iatrogenic colonic barotrauma is a well-documented entity, mostly due to endoscopic procedures. Compressed air pressure colorectal injury is less frequent, and the exact mechanism is not defined clearly to date. We present our experience of managing high transanal barotrauma to the colorectum in two similar cases presented with massive pneumoperitoneum, pneumothorax, and pneumomediastinum, a rare presentation in emergency departments, with an accident being the common etiology, where both the patients presented with massive abdominal distension and respiratory distress with diffuse subcutaneous emphysema. A huge amount of gas was noted in the peritoneal cavity on radiographs; the FAST examination was inconclusive and attributed to emphysema impeding the diagnosis. A big gush of air was noted during temporary pneumoperitoneum decompression and laparotomy. Multiple seromuscular tears with perforation in the transverse colon were identified and primarily repaired in the first patient, and the second one had perforation at the rectosigmoid junction, which was brought out as a stoma. The restoration of the stoma was done after ensuring adequate anal tone, with both patients doing well in the follow-up period. [ABSTRACT FROM AUTHOR]

Background: Eustachian tube balloon dilation (ETBD) has been Food and Drug Administration (FDA) approved for refractory Eustachian tube dysfunction since 2016. While ETBD is generally seen as safe, the complication profile has not been well defined. Objective: The objective of this study was to utilize the FDA manufacturer and user facility device experience (MAUDE) database to better assess adverse events (AE) related to ETBD. Methods: This is a study of a multiinstitutional database maintained by the U.S. FDA. A database analysis was performed via the collaboration of multiple clinicians at tertiary referral centers. The FDA MAUDE database was queried for all medical device reports (MDR) related to ETBD devices from January 2012 to November 2022. Eighty-eight unique MDR were identified, 16 of which met inclusion criteria. Results: Three MDRs were classified as device-related (18.8%); none resulted in an AE. Thirteen MDRs (81.3%) were patient-related; all were classified as AEs. The most common AE was postoperative subcutaneous emphysema (n = 6, 46.2%). Of the patients with subcutaneous emphysema, there was a wide range of severity. The most severe AE (n = 1, 6.3%) was postoperative stroke secondary to carotid artery dissection. Conclusion: Though ETBD is generally seen as a safe procedure, there have been several concerning AEs reported to date. Increased awareness of ETBD complications can serve as a primer for improved patient education and counseling during the informed consent process and aid surgeons in clinical decision-making. Future studies with standardized reporting protocols are warranted to create a central registry for ETBD. [ABSTRACT FROM AUTHOR]

To compare the safety and efficacy between Veress needle insertion and direct trocar insertion in laparoscopic surgeries. Relevant clinical trials were retrieved from major databases; Web of Science, Cochrane CENTRAL, PubMed, and SCOPUS. The following outcomes were pooled for analysis: failed entry, extraperitoneal insufflation, vascular lesion, omental lesion and visceral lesion, site bleeding, reintervention, subcutaneous emphysema, solid organ lesion, and infection of the trocar site. A fixed-effects model was used to analyze homogeneous outcomes, whereas random-effects models were used to analyze heterogeneous outcomes. We included a total of twelve clinical trials. The pooled analysis showed that the Veress needle was accompanied by a significant increase in the incidences of extraperitoneal insufflation (RR = 0.204; 95% Cl [0.136, 0.307], P = 0.001), omental lesion (RR = 0.444 95% Cl [0.239, 0.825], P = 0.01), and failed entry (RR = 0.169 95% Cl [0.101, 0.284], P = 0.001). There is no significant difference between both cohort regarding the vascular lesion (RR = 0.847 95% Cl [0.259, 2.777), P = 0.7), infection of the trocar site (RR = 0.583 95%Cl [0.106, 3.216], P = 0.5, and visceral lesion (RR = 1.308 95% Cl [0.314, 5.438], P = 0.7. The DTI was accompanied by a significantly lower incidence of complications such as extraperitoneal insufflation, failed entry, omental lesion, and subcutaneous emphysema. On the other hand, both cohorts showed similar results regarding; vascular lesions, visceral lesions, reintervention, site bleeding, and solid organ lesion. [ABSTRACT FROM AUTHOR]

Copyright of Cukurova Medical Journal / Çukurova Üniversitesi Tip Fakültesi Dergisi is the property of Cukurova University, Faculty of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Blunt neck trauma can cause airway obstruction with pneumomediastinum and neck subcutaneous emphysema, necessitating early management. Blunt neck trauma is an uncommon condition in sports yet life-threatening if left untreated; hence, early diagnosis and management is necessary once suspected. We report a collegiate rugby player tackled around the neck during intersquad scrimmage. He broke his cricoid and thyroid cartilage, resulting in cervical subcutaneous emphysema and pneumomediastinum and eventually, airway obstruction. Thus, he underwent cricothyroidotomy and emergency tracheotomy. After 20 d, the emphysema disappeared. However, dilation failure of the vocal cord remained, thereby requiring laryngeal reconstruction. In conclusion, blunt neck trauma can cause airway obstruction in various sports. [ABSTRACT FROM AUTHOR]

Subcutaneous emphysema caused by dental treatment is uncommon. This study retrospectively investigated cases of dental treatment-induced subcutaneous emphysema. Eleven patients were diagnosed with subcutaneous emphysema at our hospital between 2011 and 2021. We evaluated patient age, sex, medical history, origin tooth, dental procedure, cause, range, healing period, duration of antibiotic, and complication. The influence of patient age, extent of the emphysema, or dental procedure on the healing period was statistically analyzed. The average patient age was 48.0 ± 20.0 years. The incidence of subcutaneous emphysema was not related to age but was more common in females. Of the 11 patients, 4 had subcutaneous emphysema that spread to the chest. Patients undergoing surgical procedures requiring an air turbine or electric handpiece seemed to be at the greatest risk of developing subcutaneous emphysema. The average healing period and duration with antibiotic treatment were 8.18 ± 1.78 days, and 10.09 ± 4.30 days, respectively. The statistical results showed a significant difference in the healing period between presence and absence of systemic medical history. The results of this study suggests that subcutaneous emphysema occurs more frequently following surgical procedures requiring an air turbine or electric handpiece, and the presence or absence of systemic medical history affects the healing period. [ABSTRACT FROM AUTHOR]

Spontaneous pneumomediastinum is defined as the presence of air in the mediastinum not associated with trauma or iatrogenic causes. This pathology is rare in the pediatric population. Case 1: A previously healthy 15-year-old male was admitted with a 5-day history of sudden-onset chest pain associated with odynophagia. Upon admission, there were no signs of respiratory distress, but slight subcutaneous emphysema in the neck. A neck X-ray demonstrated extensive prevertebral and paracervical air. Chest x-ray showed increased transparency and delineation of the mediastinal contours as well as increased retrosternal space, all compatible with pneumomediastinum. Chest CT showed extensive emphysema of the supra- and infrahyoid anterior neck bilaterally. Neither the esophagram nor the upper endoscopy reveal an esophageal lesion. The patient remained stable without the need for supplemental oxygen, started a liquid diet 72 hours post admission with adequate tolerance, and was discharged home on the fourth day of hospitalization. Case 2: A previously healthy 10-year-old female was admitted to the emergency department with a clinical picture of odynophagia that prior to admission was associated with signs of respiratory distress and desaturation. Chest X-ray showed subcutaneous emphysema in the left cervical, thoracic, and axillary regions. Chest CT scan with oral contrast showed emphysema of the soft tissues of the left chest wall and neck and no extravasation. Upper endoscopy showed no lesions in the upper digestive tract. She resumed oral feedings 2 days post admission and was discharged home 6 days post admission. Spontaneous pneumomediastinum is an infrequent benign clinical entity in children, especially in those with no history of lung disease, infections or substance abuse. Conservative treatment is successful in most cases. Rapid reinitiation of oral feedings does not increase complications and allows an early discharge. [ABSTRACT FROM AUTHOR]

Clinically amyopathic dermatomyositis (CADM) is a rare condition characterized by dermatomyositis skin lesions without clinically apparent muscle involvement. Respiratory involvement is common, occurring in about half of the cases. Spontaneous pneumomediastinum (PnM) is a rare, and often fatal, complication of CADM. We report a case of a 61-year-old female patient who was diagnosed with anti-melanoma differentiation-associated gene 5 antibody-associated CADM and interstitial lung disease. She developed an extensive spontaneous PnM with subcutaneous emphysema. The patient was treated with a conservative approach which was, initially, successful in reducing the size of the PnM. However, the patient died from an eventual nosocomial pneumonia requiring mechanical ventilation. This case illustrates that improving the management of CADM associated PnM, remains a major unmet need. [ABSTRACT FROM AUTHOR]

Subcutaneous emphysema (SE) is defined as the unintentional accumulation of air or carbon dioxide in the soft tissue under the skin. This phenomenon can occur spontaneously, or be a result of trauma, infection, or surgical complications. It commonly occurs in the chest wall and neck, but can also happen in other parts of the body. Typical signs and symptoms of SE includes: crepitus, swelling in the neck and face as well as pain in the chest. This report discusses the case of a patient whose surgical course was complicated by spontaneous SE. [ABSTRACT FROM AUTHOR]

An 8-y-old, castrated male Siberian Husky dog was admitted to an emergency clinic with acute collapse and severe swelling of both forelimbs, ventral thorax, and axillary region. The clinical assessment, with laboratory tests and radiologic investigation, confirmed severe subcutaneous emphysema and multi-organ failure. The animal died while receiving emergency treatment. On postmortem examination, Clostridium perfringens was isolated from the subcutaneous fluid and the effusion from the thoracic and abdominal cavities. Relevant histopathology findings included subcutaneous emphysema and multi-organ perivascular and intravascular, intralesional myriad 0.5–3-µm gram-positive rod bacteria, with no associated inflammation. Whole-genome sequencing and phylogenetic analysis identified C. perfringens type A. Virulence genes detected included cpa (alpha toxin), cadA (v-toxin), colA (collagenase A), nagH (hyaluronidase), nanH, nanI, nanJ (sialidases), and pfoa (perfringolysin). These virulence genes have previously been reported to act synergistically with alpha toxin in C. perfringens– mediated gas gangrene. [ABSTRACT FROM AUTHOR]

Copyright of Revista Horizonte Médico is the property of Universidad de San Martin de Porres and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Benign subcutaneous emphysema of the upper limb is extremely uncommon. Patients with this condition that involves the limbs usually present with local symptoms, and they are systematically well. We report a case of 18-year-old male presented after a minor cut wound in the forearm with diffuse subcutaneous emphysema. The patient was treated with hyperbaric oxygen therapy after wound exploration. Recovery was uneventful. Infectious etiology by gas-forming organisms should be ruled out before considering other causes. [ABSTRACT FROM AUTHOR]

Background: Spontaneous pneumomediastinum, pneumothorax and spontaneous subcutaneous emphysema are rare entities. A rising trend in the setting of COVID-19 even in patients who are not put on invasive ventilation can suggest an alternative aetiology. Case presentation: We describe four cases which presented with suspected symptoms of COVID-19 and were diagnosed with pneumomediastinum, pneumothorax, and subcutaneous emphysema which would have been missed if not for computed tomography scan performed at the time of admission. Three of these cases had no prior history of any iatrogenic intervention, and the fourth person developing pneumothorax and subcutaneous emphysema after intubation. Conclusions: Pneumomediastinum, pneumothorax and subcutaneous emphysema can be noted as a complication of COVID-19 itself as well as the complication of management of COVID-19. [ABSTRACT FROM AUTHOR]

This brief clinical report describes a case of the self-induced cervicofacial emphysema. There are many factors that cause cervicofacial subcutaneous emphysema including air-driven handpieces used in dental clinic, maxillofacial trauma, improper chest tubing, neck surgery, or otic surgery. However, there are rare cases of self-induced subcutaneous emphysema due to dehiscence of external auditory canal. In this study, we reported a patient who developed spontaneously subcutaneous emphysema with persistent otitis externa and communication between external auditory canal and temporomandibular joint. A 66-year-old male visited the emergency room with right facial swelling and had crepitus on palpation at right temporal and TMJ area. Enhanced head and neck CT imaging revealed extensive emphysema in masticatory spaces and subcutaneous space of neck area. Cone-beam CT showed a defect in the anterior wall of the external acoustic canal. This canal was occluded using packing of ciprofloxacin soaking gauze. After that, the emphysema was completely disappeared and there was no recurrence at follow up for 3 years after treatment. [ABSTRACT FROM AUTHOR]

• Laryngeal emphysema is a rare and critical complication following thoracic surgery. • Pressurised accumulation of air in the neck results in compression of the larynx. • Awareness and identification of laryngeal emphysema allows rapid management. • Securing upper airway patency via a multidisciplinary approach is the primary goal. • Early recognition of subcutaneous emphysema helps prevent laryngeal emphysema. [ABSTRACT FROM AUTHOR]

The first hiatal hernia repair using a laparoscopic technique was performed in 1946 by the famous surgeon Rudolf Nissen. 1 Laparoscopic surgery is frequently the preferred alternative to laparotomy due to its benefits. Laparoscopic technique provides less risk for postoperative pain, shorter hospitalization, decreased risk of hemorrhage, and the cosmetic benefit of less cutaneous scarring. Nonetheless, laparoscopy requires the creation of a pneumoperitoneum using CO2 insufflation resulting in potential complications. Insufflation resulting in subcutaneous emphysema has an occurrence rate of 0.43% to 2.3% and the potentially severe complication of pneumothorax formation. 2 [ABSTRACT FROM AUTHOR]

Background and Objectives: Uniportal thoracoscopic segmentectomy under intubated general anesthesia with one-lung ventilation has recently been introduced for the management of lung cancer patients with small tumors or compromised cardiopulmonary function. However, uniportal thoracoscopic segmentectomy without endotracheal intubation had rarely been performed. Therefore, in this study, we aimed to evaluate the feasibility and safety of this novel technique.Methods: From January 2014 to November 2018, 32 lung cancer patients were treated using nonintubated uniportal thoracoscopic segmentectomy under a combination of target-controlled infusion of propofol, nasal high-flow oxygen therapy, intrathoracic intercostal nerve blockade, and vagal nerve blockade. Sixty-two other lung cancer patients who underwent initial planning nonintubated multiportal thoracoscopic segmentectomy during the same period were included as the control group.Results: Preoperative dye localization was required in 18 (56.3%) patients of uniportal group. No patients required conversion to tracheal intubation or thoracotomy. Two patients were converted from the one-port to the two-port approach due to severe adhesions in the pleural cavity. The mean durations of anesthetic induction and surgery were 12.7 min and 101.1 min, respectively. Postoperative complications were noted in two patients (2/32, 6.3%) of uniportal group: one had subcutaneous emphysema and the other had prolonged air leaks over 3 days. The median durations of postoperative chest drainage and hospital stay were 1 and 3 days in uniportal group, respectively.Conclusion: Nonintubated uniportal thoracoscopic segmentectomy is technically feasible and safe for selected patients. It can be an attractive alternative to intubated thoracoscopic segmentectomy for patients with early lung cancer. [ABSTRACT FROM AUTHOR]

Non-infectious subcutaneous emphysema of the hand has previously been mentioned in literature. In most cases, it presents in a benign and self-resolving form, which may be managed conservatively. However, in cases of subcutaneous emphysema involving insufflation with nitrogen gas, clinical vigilance is advised as acute compartment syndrome may be a potential complication due to the non-permeative nature of the gas. This would necessitate a complete change in the dynamics of management, warranting urgent surgical intervention. Current literature on acute compartment syndrome of the hand complicating subcutaneous emphysema is scarce. This report aims to highlight this unique case and add to the current literature on this rare condition. [ABSTRACT FROM AUTHOR]

Percutaneous dilatation tracheostomy (PDT) has been widely used in Indonesia, yet no study to evaluate the outcome of PDT compared to surgical tracheostomy (ST) is available. Objective: This study was aimed to evaluate the use of PDT in Indonesia. Design: Non-randomized comparative retrospective study. Setting: Intensive Care Unit of Wahidin Sudirohusodo Hospital Makassar. Patients: Eighty-four patients aged 15 to 90 years, undergone tracheostomy during 2016 to 2017 were evaluated. Measurements and results: Samples were evaluated in terms of surgical duration, blood loss volume, mortality, and complication rates such as post-operative bleeding, pneumothorax, subcutaneous emphysema, stomal infection, tracheal stenosis/malacia, and unintended fistula formation. Collected data were analyzed with SPSS version 22. Mean operative duration of PDT (18.3 minutes) were significantly faster than ST (40.2 minutes) (p<0.05), accompanied by significant reduction of mean blood loss 13.6 ml compared to 21.1 ml in ST group (p<0.05). A total of 9 complications (18.8%) found in ST group and 5 (13.9%) in PDT group, with stomal infection was the most common complications. Mortality rate were 52.8% in PDT group and 45.8% in ST group (p>0.05), none associated with the procedure itself. Conclusion: It is suggested that PDT is a superior technique in placement of tracheostomy canula. [ABSTRACT FROM AUTHOR]

A 40-year-old male double yellow-headed Amazon parrot (Amazona ochrocephala oratrix) was evaluated for a history of chronic recurrent subcutaneous emphysema. Whole-body radiographs and computed tomography imaging revealed significant subcutaneous emphysema in the right cervical area that was suggestive of a chronic ruptured cervical air sac. Surgical exploration of the right cervical area revealed a 4cm defect in the right cervical air sac. The defect was sutured in a double-layer closure first of the thickened air sac tissue, followed by the subcutaneous layer with 5-0 polydioxanone. Following closure of the skin, the remaining air was aspirated from the subcutaneous space. The patient healed without complication, and on last follow-up approximately 5 months postsurgery, there was no sign of recurrence of subcutaneous emphysema, demonstrating successful primary closure of the chronic ruptured cervical air sac. Surgical management of a chronic air sac rupture was successful in resolving recurrent subcutaneous emphysema in an Amazon parrot. The clinical findings, diagnostic approach, anesthesia, surgical technique, and postoperative outcome are described in this clinical report and can aid clinicians presented with cases of chronic, recurrent subcutaneous emphysema that are refractory to other treatments. [ABSTRACT FROM AUTHOR]

Background: First described in the early 1990s, endoscopic orbital decompression has become increasingly popular and has been shown to be a safe and effective approach for surgical decompression of the medial and inferior orbit. Methods: We present our preferred technique for performing an endoscopic orbital decompression, highlighting key pearls and pitfalls. Results: An endoscopic wide maxillary antrostomy and sphenoethmoidectomy is performed in standard fashion. We prefer to resect the middle turbinate for optimal exposure and access. The medial orbital wall is skeletonized and the lamina papyracea is carefully elevated, preserving the underlying periorbita. The orbital floor medial to the infraorbital nerve is resected. Once the periorbita is fully exposed, parallel axial incisions along the medial orbit and orbital floor are made from posterior to anterior using a sickle knife, taking care not to bury the tip to avoid injuring underlying orbital contents. The remaining fibrous bands are incised and prolapse of orbital fat is observed. Post extubation bag mask ventilation is limited to avoid subcutaneous emphysema. Conclusion: Compared to open techniques, endoscopic orbital decompression provides superior visualization of critical anatomical landmarks, assures healthy sinus functioning post procedure, offers a lower complication rate, and avoids external incisions. [ABSTRACT FROM AUTHOR]

Pneumomediastinum and subcutaneous emphysema are defined as the pathological presence of free air in the mediastinum or subcutaneous tissue, respectively. In the majority of cases, pneumomediastinum is secondary to an iatrogenic cause, but has rarely been described after a routine dental extraction. This condition is generally self-limiting, but major complications can occur, such as mediastinitis, which is more frequently associated with iatrogenic pneumomediastinum. To highlight the importance of including this presumably underdiagnosed complication in the differential diagnosis, we present a case of a 50-year-old man with dysphagia, facial pain and swollen face and neck following a dental extraction. [ABSTRACT FROM AUTHOR]

Real-Time-reverse-transcription-Polymerase-Chain-Reaction from nasopharyngeal swabs and chest computed tomography (CT) depicting typically bilateral ground-glass opacities with a peripheral and/or posterior distribution are mandatory in the diagnosis of COVID-19. COVID-19 pneumonia may present though with atypical features such as pleural and pericardial effusions, lymphadenopathy, cavitations, and CT halo sign. In these two case-reports, COVID-19 presented as pneumothorax, pneumomediastinum and subcutaneous emphysema in critically ill patients. These disorders may require treatment or can be even self-limiting. Clinicians should be aware of their potential effects on the cardiorespiratory status of critically ill COVID-19 patients. Finally, pneumothorax can be promptly diagnosed by means of lung ultrasound. Although operator dependent, lung ultrasound is a useful bedside diagnostic tool that could alleviate the risk of cross-infection related to COVID-19 patient transport. [ABSTRACT FROM AUTHOR]

Rationale: Colonic barotrauma induced by high-pressure air compressors has been reported more frequently these days due to the widespread use of air compressors in industries. Such enormous pressure into the rectum can lead to devastating injuries. Patient's concern: A 35-year-old male was referred to our emergency department with an alleged history of directing high pressure compressed air jet towards the anus. There was diffuse subcutaneous emphysema over the neck, chest, abdomen, and extremities, and he presented with hemodynamic instability and respiratory failure. Diagnosis: Rectosigmoid perforation due to exposure to high-pressure air jet causing tension pneumoperitoneum, pneumomediastinum, pneumothorax, and extensive subcutaneous emphysema. Intervention: In view of tension pneumoperitoneum, urgent percutaneous needle decompression was performed using 16 G needle, 5 cm superomedial to the anterior superior iliac spine. The gush of air was released along with reduction in abdominal distension and improvement in hemodynamics. Outcome: The patient succumbed two days later due to septic shock. Lessons: This case highlighted the importance of promoting education about work safety among industrial workers especially in developing countries like India. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome virus coronavirus 2 (SARS-CoV-2). As known, COVID-19 has become a global pandemic and serious health problem. Disease mainly affects lungs and common findings are fever cough and shortness of breath. Computerized tomography (CT) has an important role in initial evaluation and follow up of COVID-19. Main (CT) finding of the disease is bilateral extensive ground-glass opacification (GGO) with a peripheral or posterior distribution, mainly involving the lower lobes. In this case report, we present a pneumothorax and subcutaneous emphysema case in a patient with COVID-19. To the best of authors' knowledge, it is the first illustrated case of pneumothorax accompanying COVID-19 pneumonia. [ABSTRACT FROM AUTHOR]

• Pneumomediastinum associated with pneumothorax and subcutaneous emphysema is a rare complication and is called "Hamman's syndrome". • It usually happens during the second stage of labor because of the rupture of marginal alveoli into perivascular tissue planes. • There is no specific treatment, but multidisciplinary involvement is essential. • Prognosis is generally favorable. Pneumomediastinum associated with pneumothorax and subcutaneous emphysema also known as Hamman's syndrome is a rare obstetric complication that usually happens during the second stage of labor. The causal mechanism of Hamman's syndrome is thought to be due to excessive intrathoracic pressure associated with Valsalva maneuver which leads to distal alveolar rupture. The released alveolar air from alveolar rupture dissects along the vascular sheets down a pressure gradient toward the pulmonary hila and into the mediastinum. Prognosis is generally favorable. We report the case of physiologic pregnancy in a multipara parturient, which was complicated in the late second stage of labor with subcutaneous emphysema, pneumomediastinum, and severe pneumothorax. Recovery occurred after seven days of active management and a chest tube insertion. No complications were seen afterwards. Pneumomediastinum associated with pneumothorax and subcutaneous emphysema in the absence of an obvious precipitating cause is a rare obstetric complication and is called "Hamman's syndrome". The incidence of relapse is unknown, due to the number of reported cases. It could be reasonable to develop a delivery plan at 37 weeks of gestation for women with the history of Hamman syndrome. In case of tendency for a large fetus it might be wise to consider earlier induction of childbirth. Non-aggressive management of the second period of childbirth is recommended. In case of prolonged labour surgical delivery by caesarean section could be considered. [ABSTRACT FROM AUTHOR]

Highlights • Massive mediastinal emphysema is rare signs of colon perforation. • The diagnosis may be delayed due to the absence of peritoneal irritation. • Laparotomy should be considered in case of colonic penetration with the mediastinum emphysema. Abstract Introduction Mediastinal and subcutaneous emphysema usually result from spontaneous rupture of the alveolar wall. We present an extremely rare case of massive mediastinal, retroperitoneal, and subcutaneous emphysema due to the penetration of the colon into the mesentery. Presentation of case A 57-year-old man presented to our institution with a history of chest pain. The patient's medical history included malignant rheumatoid arthritis during the use of steroids and an immunosuppressive agent. The patient had no signs of peritoneal irritation or abdominal pain. A chest radiography revealed subcutaneous emphysema of the neck, mediastinal emphysema, as well as subdiaphragmatic free air. Computed tomography showed extensive retroperitoneal, mediastinal, and mesenteric emphysema of the sigmoid colon without pneumothorax. Diagnostic laparoscopy was performed and revealed perforation into the sigmoid mesentery. Segmental resection of the sigmoid colon and end-colostomy were performed. The diverticulum was communicating with the outside of the mesentery via the mesentery. The mediastinal emphysema disappeared a few days after the surgery. Discussion Colonic perforation generally results in free perforation. Colonic gas may spread via various anatomical pathways when perforation of the colon occurs in the retroperitoneum; thus, diverse atypical clinical symptoms may be present. Signs of peritoneal irritation can be hidden in cases of retroperitoneal colonic perforation. The atypical manifestation of a retroperitoneal colonic perforation can cause difficulties in making a diagnosis. Conclusions Massive mediastinal and retroperitoneum emphysema are rare signs of colonic perforation. Emergency laparotomy should be considered in colonic penetration of the diverticulitis where the emphysema expands to the mediastinum extensively. [ABSTRACT FROM AUTHOR]

Abstract Third molar extraction is a common procedure in dental surgery. Common complications that may occur post procedure include pain, trismus, bleeding, dry socket, and nerve injuries. Subcutaneous emphysema is an uncommon complication. A rare case of extensive cervicofacial subcutaneous emphysema, pneumomediastinum, and pneumorrhachis following third molar extraction is reported here. Issues relating to the diagnosis, aetiology, and management of these complications are discussed. [ABSTRACT FROM AUTHOR]

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Background: Aim of this study is to report and to analyze the incidence, clinical impact and treatment options of ectopic air localizations after transanal procedures.Methods: A systematic literature review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The research was carried out using the PubMed database, identifying 40 articles with the following keywords: "transanal" AND "emphysema"; "transanal" AND "subcutaneous emphysema"; "transanal" AND "pneumomediastinum"; "transanal" AND "pneumothoraces"; "transanal" AND "pneumopericardium"; "transanal" AND "retropneumoperitoneum".Results: Nineteen articles, published between 1993 and 2017, were included in the study for a total of 29 patients. The most frequent air localization was in the retroperitoneum, followed by subcutaneous tissues, mediastinum and neck. This condition was treated conservatively in 20 patients, with colostomy in 4 patients, with bowel resection and negative diagnostic laparoscopy in one patient each. In three cases the treatment was not specified. Ectopic air location resolved in all cases.Conclusions: Pneumo-mediastinum and pneumo-retroperitoneum after transanal procedures are unusual complications with a dramatic radiological appearance but can be managed successfully with a completely benign course in most cases. Initially, a conservative approach is recommended. Surgical treatment should be reserved only in case of fluid collection or suture dehiscence. [ABSTRACT FROM AUTHOR]

Pneumothorax, pneumomediastinum and/or subcutaneous emphysema are important differential diagnosis for patients manifesting dyspnea or chest pain in the emergency department (ED). Inhalation of methamphetamine as well as other abuse substances could rarely induce above-noted complications. However, most ED patients are reluctant to reveal the use of illicit substances. Therefore, prompt toxicologic screening is warranted in confirming the diagnosis of substance abuse in the ED. We herein report a 22-year-old male patient who presented to the ED with diffuse subcutaneous emphysema, pneumomediastinum and pneumothorax after methamphetamine inhalation. The diagnosis of methamphetamine abuse was delayed because the patient did not provide the accurate drug exposure history at the outset. With the help of appropriate toxicologic screening, the diagnosis was finally made and early counseling was provided to prevent further drug abuse and the recurrence of pneumothorax/pneumomediastinum. [ABSTRACT FROM AUTHOR]

Introduction Subcutaneous emphysema (SE) is a frequent and often self-limiting complication of tube thoracostomy or other cardiothoracic procedures. On rare occasions, severe and extensive surgical emphysema marked by palpable cutaneous tension, dysphagia, dysphonia, palpebral closure or associated with pneumoperitoneum, airway compromise, “tension phenomenon” and respiratory failure require treatment. Presentation of case A 67 year old lady presented with a large spontaneous pneumothorax on the background of end-stage chronic obstructive pulmonary disease (COPD) and newly diagnosed lung cancer, developed extensive surgical emphysema following insertion of a chest drain. Immediate improvement was observed after insertion of a large-bore, 26 French (Fr.) intercostal catheter, subcutaneous drain which was maintained under low suction (−5 cm H 2 O) for a further 24 h. Discussion Several methods have been described in the literature for the treatment of extensive subcutaneous emphysema, including: emergency tracheostomy, multisite subcutaneous drainage, infraclavicular “blow holes” incisions and subcutaneous drains or simply increasing suction on an in situ chest drain. Here a large-bore, fenestrated, subcutaneous drain maintained on low negative pressure also provided the necessary decompression. Conclusion In the absence of a comparative study to identify the most effective method to manage extensive subcutaneous emphysema, this case highlights an effective, simple and safe management option. [ABSTRACT FROM AUTHOR]

Although rare, subcutaneous air emphysema can occur during dental procedures such as endodontic treatment, surgical extractions, and preparing a tooth for an indirect or direct dental restoration. We report the development of a subcutaneous air emphysema that was introduced through the periodontal ligament of an untreated premolar after the use of an air syringe to dry the tooth. [ABSTRACT FROM AUTHOR]

The curtain sign (CS) is a sonographic artifact found in lung ultrasound studies. It is generally used to describe the appearance of an expanded and aerated lung, often in the context of pleural effusion diagnosis. In emergency and critical care ultrasound use, the recognition of changes to the CS is very useful in the detection of early pulmonary pathological processes occurring at the lateral lung bases and costophrenic recesses. The author suggests a simple standardisation of the CS description and describes its use in lung ultrasound. [ABSTRACT FROM AUTHOR]