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      Extensive subcutaneous emphysema following lobectomy

      case-report

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          Abstract

          We present a case report of extensive subcutaneous emphysema secondary to an elective left upper lobectomy. A 65-year-old gentleman was brought into a London teaching hospital’s Accident and Emergency department following report of severe swelling. He was mistakenly treated by the paramedics as an allergic reaction and given hydrocortisone and salbutamol nebulisers with no effect. Upon arrival, the patient had widespread crepitus extending from his peri-orbital muscles down to mid-torso. A computer tomography scan revealed a pleuro-cutaneous fistula at the site of a recently sited chest drain, with extensive emphysema and a pneumothorax. A Seldinger chest drain was successfully inserted under blind technique following two attempts. This case highlights the risk of subcutaneous emphysema following thoracic surgery, the importance of correct diagnosis and the difficulties of left-sided intercostal drains in patients with subcutaneous emphysema.

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          Most cited references18

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          BTS guidelines for the insertion of a chest drain.

          D Laws (2003)
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            Massive spontaneous subcutaneous emphysema. Acute management with infraclavicular "blow holes".

            Four patients who recently developed massive spontaneous subcutaneous emphysema in our intensive care unit are reported. No obviously remediable intrathoracic process was found in any of these patients. The acute physiologic impairment and grotesque cosmetic deformity were immediately alleviated by making bilateral 3-cm infraclavicular incisions down to the pectoralis fascia. These acutely decompressed the progressive subcutaneous dissection and each patient's subcutaneous emphysema resolved without any additional invasive therapy.
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              Management of alveolar air leaks after pulmonary resection.

              Air leaks are a common problem after pulmonary resection and can be a source of significant morbidity and mortality. Air leaks are associated with prolonged hospital stays, and infectious and cardiopulmonary complications, and they occasionally require reoperation. Despite reasonably robust literature on the topic, the optimal approaches to manage postoperative air leaks remain controversial. We used available literature and expert consensus to formulate suggestions regarding the preferred approaches to both routine and prolonged alveolar air leaks. This review summarizes our findings. Copyright (c) 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                SAGE Open Med Case Rep
                SAGE Open Med Case Rep
                SCO
                spsco
                SAGE Open Medical Case Reports
                SAGE Publications (Sage UK: London, England )
                2050-313X
                06 May 2018
                2018
                : 6
                : 2050313X18773667
                Affiliations
                [1 ]Emergency Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
                [2 ]London North West Healthcare NHS Trust, London, UK
                Author notes
                [*]Fiqry Fadhlillah, Emergency Department, Chelsea and Westminster Hospital, 369 Fulham Rd, Chelsea, London SW10 9NH, UK. Email: fiqry.fadhlillah@ 123456nhs.net
                Author information
                https://orcid.org/0000-0002-2013-9996
                Article
                10.1177_2050313X18773667
                10.1177/2050313X18773667
                5946586
                2216aaf9-2238-4a6d-89ee-d2954d3c68ff
                © The Author(s) 2018

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 15 December 2017
                : 5 April 2018
                Categories
                Case Report
                Custom metadata
                January-December 2018

                surgery,radiology,critical care/emergency medicine,cardiothoracic,subcutaneous emphysema

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