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Subcutaneous emphysema is a well-known complication of chest tube insertion that can become life-threatening. Severe cases often progress rapidly, necessitating prompt intervention to prevent complications such as airway obstruction and respiratory failure. We report the case of a 57-year-old man who developed extensive subcutaneous emphysema following chest tube insertion. Despite the reinsertion of the chest tube, the patient's symptoms worsened, prompting the use of a subcutaneous cannula. Two 14G subcutaneous cannulas were placed in the anterior chest wall, resulting in rapid decompression and significant symptom relief. The subcutaneous cannula technique is a simple, cost-effective, and minimally invasive method for managing severe subcutaneous emphysema. This approach offers a viable alternative to more invasive techniques, with the potential for rapid symptom resolution and reduced complications., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Lim et al.)

Hamman syndrome, or spontaneous pneumomediastinum, is a rare condition characterized by the presence of free air in the mediastinum, often triggered by increased intrathoracic pressure from vomiting, coughing, or intense physical exertion. Its association with diabetic ketoacidosis (DKA) is extremely uncommon. We report a case of an 18-year-old male with poorly controlled type 1 diabetes who developed DKA complicated by pneumomediastinum, subcutaneous emphysema, and a small pneumothorax. The condition was likely precipitated by Kussmaul's respiration and severe vomiting. After treatment for DKA with insulin and fluids, the patient improved, and follow-up imaging showed complete resolution of the pneumomediastinum. This case underscores the importance of recognizing and managing this rare complication in patients with DKA., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Daher et al.)

Pneumomediastinum, often a silent yet disruptive force in the context of trauma, complicates clinical decision-making, particularly when it is accompanied by pneumothorax, pneumoperitoneum, and pneumoretroperitoneum. The Macklin effect, where air dissects along tissue planes following alveolar rupture, frequently underpins these findings, adding layers to the diagnostic puzzle. In this case, an 18-year-old male involved in a high-speed vehicle collision was transferred to our trauma center intubated and sedated. Initial imaging painted a daunting picture: pneumomediastinum, a sizable left-sided pneumothorax, and extensive subcutaneous emphysema. Further, a whole-body computed tomography scan revealed the additional complications of pneumoperitoneum and pneumoretroperitoneum. Despite the concerning radiographic findings, endoscopic evaluations found no evidence of esophageal or bronchial injury. Management was conservative, including chest tube placement and monitoring, and resulted in a gradual resolution of symptoms. The patient's in-hospital course was uneventful, and he was discharged in stable condition without further complications. The presence of pneumomediastinum with associated air in other compartments triggers a reflex to consider severe, life-threatening conditions like esophageal rupture. However, this case highlights the importance of differentiating between such critical injuries and less ominous causes like the Macklin effect. In trauma, the art lies in knowing when to intervene and when to trust the body's capacity to heal, supported by careful observation and conservative management., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Alrahmani et al.)

Hamman syndrome is a rare and benign condition characterized by the presence of air in the mediastinum without an external cause. It most commonly occurs in young adults and is often triggered by activities that increase intrathoracic pressure, such as coughing, vomiting, or asthma exacerbations. We report the case of an 18-year-old male patient with a history of asthma who presented with shortness of breath, chest pain, and subcutaneous emphysema. Imaging evaluation revealed pneumomediastinum, interlobar pneumothorax, pneumopericardium, pneumorrhachis, and subcutaneous emphysema. The patient was treated with supplemental oxygen and analgesia. The symptoms gradually improved, and follow-up imaging confirmed the resolution of pneumomediastinum within four days. Hamman syndrome is commonly misdiagnosed due to its non-specific clinical presentation. Imaging evaluation is crucial for diagnosis and for differentiating it from other serious conditions. This case report illustrates a rare combination of uncommon imaging findings in Hamman syndrome., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ferreira et al.)

Spontaneous pneumomediastinum (SPM) is a rare clinical entity typically associated with underlying pulmonary disease or trauma. However, it has also been linked to illicit drug use, with cocaine being one of the most common. We present the case of a previously healthy 23-year-old patient who arrived at the emergency department with retrosternal pain, odynophagia, dyspnea, and crepitus in the neck and chest after inhaling cocaine for three consecutive days. The patient was hemodynamically stable, with extensive subcutaneous emphysema in the neck and chest. Computed tomography of the neck and chest revealed abundant air dissecting the superficial and deep planes of the neck and mediastinum, particularly in its upper and middle portions. Additional studies included nasolaryngoscopy, which showed white material suggestive of inhaled substance use. An upper gastrointestinal endoscopy was performed to rule out perforation, which did not identify any lesions. Blood tests showed no abnormalities. Conservative management with analgesia and monitoring was initiated, resulting in the improvement of subcutaneous emphysema and pain. The patient was discharged after a two-day hospital stay. There were no complications or further visits to the institution within the following six months. This case highlights the importance of investigating a history of illicit drug use, particularly cocaine, in cases of spontaneous pneumomediastinum. Our findings support the generally benign course of this condition and the effectiveness of conservative management in the absence of complications., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Jaramillo Escobar et al.)

Having a large live fish stuck in the throat is rare and prompts the urgent need to secure a definitive airway. Such sizeable foreign body (FB) in the aerodigestive tract also poses a constant threat of hollow viscus perforation, and the removal process can be complex. This report describes a fishing mishap causing the impaction of a large live fish in the laryngopharynx and esophagus, leading to respiratory distress and upper esophageal perforation. The paper highlights the mechanism of injury, emergent airway management, anatomical consideration of the location of the FB, and technical challenges in FB removal. After endotracheal intubation, the depth and location of the live fish were confirmed with a plain radiograph. The removal of the live fish was eventually successful after dislodging its fins from the laryngopharynx and rotating its head out from the upper esophagus endoscopically. The upper esophageal perforation healed with non-operative management, and the patient was discharged well., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Fu et al.)

Hamman's syndrome, or spontaneous pneumomediastinum, refers to free air in the mediastinum without an apparent cause and typically affects young people. This case report describes a 33-year-old man who presented with neck swelling following excessive vomiting due to alcohol consumption. Clinical examination revealed subcutaneous emphysema of the neck, and imaging confirmed pneumomediastinum. Initial suspicion of Boerhaave syndrome led to aggressive supportive management, but further imaging ruled out oesophageal perforation, confirming Hamman's syndrome. The patient was treated conservatively and discharged after a successful trial of a light diet. This case highlights the diagnostic challenges of Hamman's syndrome, given that its symptoms overlap with more serious conditions like Boerhaave syndrome. Prompt recognition and appropriate conservative management are essential for favourable outcomes, emphasizing the benign and self-limiting nature of Hamman's syndrome., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Umar et al.)

Spontaneous pneumomediastinum (SPM) is an uncommon condition characterized by air in the interstices of the mediastinum. Management generally involves supportive care; however, if a patient inspires high concentrations of oxygen, the mediastinal air will be absorbed faster. A 23-year-old man who presented with acute-onset breathlessness with a history of more than a year of lower backache was diagnosed with SPM and accompanying ankylosing spondylitis (AS) by a chest CT and spinal MRI and was treated conservatively. This case is being reported for its uniqueness, as SPM with underlying AS is rare., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Chilukuru et al.)

Pneumomediastinum (PM) and subcutaneous emphysema are characterized by extra-alveolar air within the mediastinum and subcutaneous tissue. PM may occur spontaneously or due to trauma or an underlying airway disease. Spontaneous pneumomediastinum (SPM) may be caused by intractable vomiting, forceful coughing, child birthing, or performing a Valsalva maneuver. However, there are limited studies or case reports that present a combination of influenza A infection and electronic cigarette (e-cigarette)-induced SPM. This case report presents SPM in a previously healthy 20-year-old female with untreated influenza A infection and a history of e-cigarette use who presented to the emergency department with fever, cough, chest pain, dyspnea, and vomiting. Her physical examination was significant for neck tenderness, subcutaneous neck crepitus, and increased respiratory effort. Diagnostic evaluation included a chest X-ray and chest computed tomography that revealed PM with subcutaneous emphysema extending into the neck, as well as a negative Gastrografin study. She was treated conservatively and discharged after two days, with a follow-up scheduled at a pulmonary clinic. This case report highlights the need for a detailed substance use history, particularly e-cigarette use, when determining the etiology of SPM in a previously healthy patient. Management for SPM is conservative and should include addressing underlying etiologies with special attention to cessation and education of e-cigarettes and illicit substances., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Sanchez et al.)

Measles is a highly infectious, vaccine-preventable viral disease that runs a devastating course in developing countries due to its association with malnutrition and poor immunization coverage. Subcutaneous emphysema (SE) is a rare complication of measles that can be challenging to manage and may portend poor outcomes if untreated. We present a case of a two-year-old unimmunized rural dweller who presented with facial, neck, and chest swellings three days after being managed for measles exanthem from a referral hospital. Clinical findings were consistent with massive SE comorbid with malnutrition complicating the convalescent stage of measles. The child failed to improve with conservative management but responded to closed thoracostomy tube drainage (CTTD) through an underwater seal bottle with intermittent negative pressure wound therapy (NPWT). The child spent 47 days in the hospital during which the social welfare unit of the hospital supported the treatment. SE is a rare complication of measles infection that can be challenging to manage, especially when comorbid with malnutrition in an indigent child. The application of a multidisciplinary team approach and the use of CTTD with NPWT may shorten the duration of hospital stay for the patient., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Mamman Na'uzo et al.)

Dysphagia is a common symptom encountered in clinical practice, typically associated with a wide range of etiologies, including structural abnormalities, inflammatory conditions, neoplasms, and neurological disorders. However, the combination of subcutaneous emphysema, vocal cord palsy, enlarged arytenoids, and pooling of saliva in a dysphagic patient represents a rare and intriguing presentation. A 33-year-old female presented at a tertiary care hospital in Western India with hoarseness of voice, difficulty in swallowing, productive cough, and neck pain for two months with an abrupt increase in the severity of all symptoms in two days. A history of chewable tobacco use for six years was disclosed. Clinical evaluation revealed a thin build with platynychia and conjunctival pallor, dental staining, drooling of saliva, the presence of extensive subcutaneous emphysema on palpation of the neck, and absent laryngeal crepitus. Endoscopic evaluation was suggestive of right vocal cord palsy and enlarged, congested arytenoid cartilages, post-cricoid growth with pooling of saliva in bilateral pyriform fossae. A CT scan of the neck showed a 2x3 cm neoplastic growth in the hypopharynx, with subcutaneous emphysema and free air foci in the head and neck region, prompting an immediate tracheostomy and biopsy of the hypopharyngeal growth with Ryle's tube insertion. Squamous cell carcinoma was confirmed on the biopsy report. Due to its rarity, the possible underlying cause of idiopathic subcutaneous emphysema should be sought whenever encountered in clinical practice since these patients are potentially misdiagnosed. A high index of suspicion among clinicians, along with a consideration of the constellation of other symptoms and clinical features of a possible underlying hypopharyngeal cancer whenever encountering such patients is of key importance for prompting further investigations and treatment., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Sahai et al.)

Emphysema of the subcutaneous tissue is an uncommon complication of dental procedures. Certain dental surgical procedures, such as extraction of teeth using air-driven handpieces and endodontic procedures are more prone to cause subcutaneous emphysema. Subcutaneous emphysema is typically self-limiting and only in a few instances has an impact on the long-term health of the patient. Patients with subcutaneous emphysema experience pain, distress and inconvenience. This paper presents a case of subcutaneous emphysema of the right canine and periorbital space following endodontic treatment of the upper right front tooth., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Padmanaban et al.)

Boerhaave syndrome is an esophagal perforation due to a rupture of the esophagus wall caused by intense vomiting with mediastinitis and subcutaneous emphysema. It is a relatively rare and potentially life-threatening ailment that requires prompt diagnosis and treatment. This case presents an overview of the syndrome, including morbidity, mortality, and treatment strategy. In this case, a 56-year-old male presented to the hospital during emergency hours with shortness of breath, chest pain, and dullness in the neck and a history of binge alcohol abuse seven days ago, followed by a severe bout of vomiting. The patient was managed conservatively, requiring another hospitalization for surgery, and was later discharged from the hospital postoperatively without any complications., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Mahant et al.)

Post-tonsillectomy emphysema is an infrequent yet critical complication that follows tonsillectomy - a prevalent surgical procedure for treating conditions like recurrent tonsillitis and obstructive sleep apnea. While tonsillectomy is generally safe, it is not without risks, including the rare occurrence of postoperative emphysema, where air accumulates abnormally in the neck and head's soft tissues, potentially leading to severe respiratory distress. We present a case of a middle-aged female who underwent tonsillectomy and subsequently developed symptoms indicative of post-tonsillectomy emphysema. Diagnosed through a combination of physical examination and imaging, her treatment involved conservative management and careful monitoring, ultimately resulting in full recovery without the need for surgical intervention., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Alzamil et al.)

Subcutaneous emphysema is a type of air leak in which air accumulates within the subcutaneous layer of the skin underneath the dermal layers. The accumulation of air can be seen on imaging in relevant body areas such as the abdomen, chest, face, or neck. During physical examination, crepitus, the sensation or sound of crackling upon palpation, is the most common associated finding. Various causes for subcutaneous emphysema exist, with one such cause being thoracostomy or chest tube placement. The trocar technique, in particular, has been associated with greater complications when compared to other techniques. Here, we present a case of subcutaneous emphysema in a neonate occurring after placement of a chest tube using the trocar technique. At this time, much of the knowledge regarding subcutaneous emphysema related to chest tube placement is in the adult population. Clinicians should be aware of this complication in neonates as the body of knowledge regarding this topic continues to grow., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Jilani et al.)

Periorbital emphysema is rare and associated with facial trauma. Its main distinguishing feature is crepitation on palpation of the edema. It resolves spontaneously in a few days, but there are cases of orbital compartment syndrome that can lead to loss of vision. Here we present the case of a 55-year-old male who came to the emergency department for bilateral periorbital edema associated with non-steroidal anti-inflammatory drug (NSAID) usage, for pain following a fall from a ladder. He was treated with antihistamines and corticosteroids, for presumed allergic reaction, but without response, and subsequently developed acute onset dyspnea. Chest x-ray revealed a left pneumothorax in the context of chest trauma. Chest CT scan after drain placement shows extensive subcutaneous emphysema. In the differential diagnosis of periorbital edema, in addition to allergic, inflammatory, and systemic causes, the traumatic ones should not be excluded., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Manata et al.)

Hamman's syndrome (HS) is characterised by spontaneous pneumomediastinum and subcutaneous emphysema. It is a rare phenomenon that can occur during labour. Its incidence is 1 in 100,000 births and predominantly affects young primiparous women with prolonged labour. Patients commonly present with subcutaneous emphysema, chest pain, and dyspnoea. We present the case of a 20-year-old primigravida female with no other medical history who had prolonged labour at 43 weeks gestation. Sudden-onset, right-sided cheek pain and swelling was noted immediately after delivery accompanied by pleuritic chest pain. Chest X-ray (CXR) and computed tomography (CT) demonstrated significant pneumomediastinum and pneumopericardium with subcutaneous emphysema extending to the neck. She was managed symptomatically in addition to antibiotics and discharged after three days with complete resolution of symptoms. No concerns were raised during the follow-up. HS is a rare phenomenon that can occur during labour, particularly in young primiparous females with a prolonged second stage. Radiological investigations in the form of CXR and CT are recommended to rule out life-threatening complications and other conditions that may require immediate management. HS occurs due to rupture of peripheral alveoli secondary to increased intrathoracic pressures from excessive Valsalva manoeuvre allowing air to dissect and enter into the mediastinum. Pneumopericardium in association with HS is extremely rare. It is particularly clinically important because it can cause cardiac tamponade requiring immediate surgical management. HS is otherwise a self-limiting condition and management is symptomatic only. Our case is unique due to the presence of pneumopericardium in association with HS, the fourth ever reported in the literature. Due to its rarity, the incidence of tamponade in this cohort of patients is yet to be delineated., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Chen et al.)

A case of a 19-year-old male with mediastinal and subcutaneous emphysema consistent with pulmonary barotrauma after diving is reported. He presented with facial swelling, voice change, chest pain, and shortness of breath after multiple dives between 8 and 12 feet deep without underwater breathing equipment in a river. Relevant radiology, including radiographs and computed tomography (CT imaging), and a discussion of pulmonary barotrauma are presented., Competing Interests: The views expressed herein are those of the author(s) and do not reflect the official policy or position of Brooke Army Medical Center, the Department of Defense, or any agencies under the U.S. Government., (Copyright © 2023, Rezentes et al.)

The use of vaping products among adolescents continues to be on the rise despite known health risks. As a result, there are increasing cases of E-cigarette or vaping product use-associated lung injury (EVALI) across the United States especially among male Caucasian users of vaping products. The clinical presentation of EVALI follows the classic pattern of acute lung injury; however, there are peculiar cases with unusual symptomatology and radiographic findings. In this report, we present a case of a 25-year-old male with hemoptysis, subcutaneous emphysema, and pneumomediastinum in the setting of EVALI. He was treated with nebulized tranexamic acid and methylprednisolone with the resolution of symptoms. The diagnostic workup and management of suspected EVALI are discussed in detail. This case highlights how EVALI can present in an atypical manner and why clinicians must be cognizant of the variations in manifestations in order to facilitate early management. Overall, this case further highlights the need for clinicians to continuously push against the use of vaping products in the adolescent group, given that the occurrence of acute lung injury at a younger age predisposes to early-onset chronic lung disease., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Babalola et al.)

Pleurocutaneous fistula (PCF) is a pathological communication between the pleural space and subcutaneous tissue. This rare condition occurs as a complication of infection, malignancy, and therapeutic procedures such as tube thoracostomies. PCF is typically confirmed with computed tomography (CT) imaging. There is no current literature describing the post-traumatic causes of PCF. We describe a PCF related to multiple rib fractures and its rapid improvement following the placement of a chest tube. This case emphasizes the importance of prompt CT imaging in trauma patients and radiographically illustrates the progression and resolution of a post-traumatic PCF., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, O'Brien et al.)

Children presenting to the Emergency Department (ED) with upper respiratory infection (URI) symptoms of unresolved cough are not uncommon. Differentiation of the child's symptoms with thorough history and physical and when appropriate, further evaluation with blood work and imaging is the responsibility of the ED physician. In a clinical environment with increasing ED visits due to nonspecific URIs in children, it is also important not to overutilize an emergent workup with unnecessary testing. Our case involves a patient with atypical symptoms and hopes to highlight the importance of keeping a broad differential for all patients upon initial evaluation. Spontaneous pneumothorax is a potentially life-threatening condition. Our five-year-old patient presented with an unresolved cough being treated by an outpatient physician. He had no prior airway disease diagnosis. Severe cough in the absence of prior airway disease is notably less likely, but not an unseen cause of spontaneous pneumothorax. Our patient, however, developed just that. He was officially diagnosed with a right-sided pneumothorax on chest x-ray, underwent supplemental oxygen therapy, and was ultimately transferred to a pediatric hospital for continuation of care. Once there, our patient gradually improved was diagnosed as an asthmatic, and was started on appropriate maintenance medications. It is important to remain vigilant when examining multiple pediatric patients in a shift and to keep in mind that even otherwise healthy pediatric patients are at risk for spontaneous pneumothorax.  Spontaneous pneumothorax is a potentially life-threatening condition. Our five-year-old patient had no prior airway disease diagnosis making spontaneous pneumothorax notably less likely, however, from severe cough our patient developed just that. He was officially diagnosed with right-sided pneumothorax, underwent supplemental oxygen therapy, and was transferred to a pediatric hospital. Once there patient gradually improved, he was diagnosed as an asthmatic and started on appropriate medication to keep his breathing stable. It is essential to keep in mind that even otherwise pediatric patients are at risk for spontaneous pneumothoraxes and we as emergency physicians must keep this in mind during our evaluation., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Cullin et al.)

Subcutaneous emphysema (SE) and pneumomediastinum are rare complications of air beneath the skin layers and in the mediastinal space, respectively, following routine dental procedures. A few cases exist in the literature. A 53-year-old female presented to the emergency department shortly after a cavity filling, with marked swelling of her right orbit, face, and neck. Physical examination and computed tomography (CT) revealed subcutaneous emphysema and pneumomediastinum. The patient was treated with prophylactic antibiotics for one week and Peridex rinse twice daily. Subcutaneous emphysema and pneumomediastinum cases have been associated with potentially life-threatening sequelae and infections. Although these conditions are almost exclusively benign and self-limiting, physicians should consider the associated fatal complications and manage accordingly. Dental providers should be able to recognize this complication and provide patients with appropriate guidance., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Deskins et al.)

Introduction: The abnormal presence of free air in the thorax, pneumothorax, and pneumomediastinum are complications for critically ill patients suffering from coronavirus disease 2019 (COVID-19). The development of these events may lead to a poor prognosis and make the management of this category of patients more difficult., Study Design: We performed an observational retrospective study, including patients with SARS-CoV-2 infection and pneumonia who were hospitalized, to analyze the cases that developed pneumothorax or pneumomediastinum as a complication., Results: A total of 28 cases (1.51%) from 1844 patients with SARS-CoV-2 pneumonia developed pneumothorax or pneumomediastinum during hospitalization. Of them, 21 (75%) needed intensive care unit admission and ventilation, and 10 (35.71) were cured., Conclusion: The male gender is more probable to be involved in the development of pneumothorax or pneumomediastinum in patients with SARS-CoV-2 pneumonia. The incidence of these events is low, and conservative treatment could provide a better outcome., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Cristea et al.)

Tracheobronchial injury is a rare but potentially fatal occurrence, with most cases resulting from penetrating trauma or blunt and iatrogenic injury during medical procedures such as endotracheal intubation, bronchoscopy, or surgery. Early recognition of clinical symptoms can help stratify patient risk and guide management, though these symptoms are often non-specific. We report the case of a 42-year-old patient who presented with post-traumatic chest pain from a sharp object. Radiographic investigation revealed pneumomediastinum and significant subcutaneous emphysema, while bronchial fibroscopy confirmed a wound on the posterior surface of the trachea. The patient underwent surgery with an uneventful postoperative course. Follow-up radiographic evaluation three weeks later showed healing of the tracheal wound and good clinical improvement., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Boukhidous et al.)

Bronchocutaneous fistula (BCF) is a pathologic communication between the bronchus and the subcutaneous tissue. Its diagnosis is made mainly by chest imaging, and bronchoscopy can help in accurately localizing the fistula. Treatment options include conservative and non-conservative approaches. We report a case of iatrogenic bronchocutaneous fistula occurring after traumatic chest tube placement in an 81-year-old man, treated efficiently with conservative management., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Mallat et al.)

With upper airway obstruction being an emergency, a high index of suspicion and proper and timely treatment planning are crucial to the patient's life. Spontaneous esophageal perforation, also known as Boerhaave syndrome, has been observed to cause subcutaneous emphysema; however, airway compromise secondary to subcutaneous emphysema is extremely rare when there is no associated broncho-tracheal injury. Here, we present a case of esophageal perforation complicated with cervical emphysema that led to acute airway obstruction requiring invasive ventilation., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Hammoud et al.)

Hamman's syndrome is an uncommon complication of labor. Its diagnosis is based on clinical suspicion and CT imaging. It is often a benign and self-limiting condition occurring in healthy patients. The risk factors are nulliparity and a prolonged second stage of labor. Hamman's syndrome has life-threatening implications that underscore the importance of early diagnosis and management to avoid any difficulty. This paper discusses the case of a 21-year-old, healthy female without allergies who was admitted to the hospital in spontaneous labor at 40 weeks of gestation. During the second stage of labor, she developed Hamman's syndrome and presented with subcutaneous emphysema, which led to an emergency C-section. After a chest and cervical CT scan that showed extensive subcutaneous emphysema and a pneumomediastinum, the patient was admitted to the ICU., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Gomes et al.)

Subcutaneous emphysema (SE ) is a phenomenon in which air occupies structures under the skin and soft tissues. Common sites for SE include the neck and chest wall, which can extend to other body regions. In this case report, we describe the development of extensive SE, pneumothorax, pneumomediastinum, and pneumoperitoneum in an elderly female following blunt trauma to her right flank. The etiology of SE is broad and includes blunt and penetrating traumas; surgical, infectious, spontaneous causes; or any condition that yields a gradient between intra-alveolar and perivascular interstitial pressures. The incidence of SE has been reported to be 1.4%, while that of spontaneous pneumothorax has been reported to be 0.8% in patients receiving a percutaneous tracheostomy. Conversely, the occurrence of SE, pneumothorax, pneumomediastinum, and pneumoperitoneum in the same patient is rare. The most common signs and symptoms of SE are neck swelling and chest pain. Involvement of the deeper tissues of the thoracic outlet, chest, and abdominal wall often manifests in severe life-threatening conditions. SE can be diagnosed by detecting edema and crepitus of the scalp, neck, thorax, abdomen, and other body regions. Radiograph imaging can confirm the presence of soft-tissue air entry. Extensive SE in the setting of pneumothorax is an unusual entity for which there is, as of now, no consensus in management. Methods of treatment include supportive care, placement of blow holes for evacuation of soft-tissue emphysema, and bilateral infraclavicular incisions. SE is a rare complication that can arise from several etiologies. At the same time, various methods for managing this phenomenon have been mentioned with varying successful outcomes., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Robinson et al.)

Subcutaneous emphysema is defined by air becoming confined in the soft tissues beneath the skin and it may occur following various surgical procedures and specific penetrating trauma. While treatment is typically conservative and not required in most cases, massive subcutaneous emphysema may cause significant morbidity and sometimes life-threatening complications such as tension pneumomediastinum and respiratory compromise. Notably, no instances of self-inflicted air insufflation into the abdominal cavity have been reported in the literature. This report depicts a case of a self-inflicted air insufflation in a 40-year-old man via penetration of his umbilicus with a manual air compressor leading to widespread subcutaneous emphysema, pneumoperitoneum, pneumomediastinum, pneumopericardium, and pneumothorax. The pathway of possible air movement between body cavities has been theorized, but excluding case reports and anecdotal evidence, treatment of severe subcutaneous emphysema is less clear. This case report intends to record this unique instance of extensive subcutaneous emphysema and to emphasize the necessity for more definitive guidelines in managing these patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Corsi et al.)