De Roeck Lynn, Van Assche Lauranne, Verhoeven Veronique, Vrints Ina, Van Thielen Jana, Tondu Thierry, Thiessen Filip
a Department of Plastic, Reconstructive and Aesthetic Surgery , ZNA Middelheim Hospital , Antwerp , Belgium.
Acta Chir Belg. 2019 Aug;119(4):251-253. doi: 10.1080/00015458.2018.1438560. Epub 2018 Feb 23.
Subcutaneous emphysema can be an alarming sign of a necrotizing soft tissue infection. However, non-infectious etiologies exist that can be treated conservatively. This case report describes a subcutaneous emphysema of unknown origin and highlights the importance of distinguishing these clinical entities. We present a 17-year old female with pain and subcutaneous emphysema of the left arm. There were no systemic symptoms. Inflammatory parameters were slightly elevated. Computed tomography (CT) scan of the chest excluded intrathoracic abnormalities. Despite antibiotic treatment, the pain increased and the emphysema extended. Necrotizing fasciitis was feared. A surgical exploration was performed and hyperbaric oxygen therapy was started. Intraoperatively, puncture marks were identified on the left arm. Air noticeably escaped, but normal, unaffected tissues were identified and microbiological cultures remained negative. We observed a good clinical evolution. The lack of apparent causes, the unexplained puncture marks and psychiatric comorbidity suggests the possibility of subcutaneous emphysema due to factitious manipulations. Patients with subcutaneous emphysema who remain clinically stable, have minimal pain and no significant inflammatory changes could be treated conservatively. Close clinical monitoring is essential to avoid delayed intervention in case of a necrotizing soft tissue infection.
皮下气肿可能是坏死性软组织感染的一个警示信号。然而，也存在一些非感染性病因，可采用保守治疗。本病例报告描述了一例病因不明的皮下气肿，并强调了区分这些临床病症的重要性。我们报告一名17岁女性，其左臂出现疼痛和皮下气肿。无全身症状。炎症指标略有升高。胸部计算机断层扫描（CT）排除了胸内异常。尽管进行了抗生素治疗，但疼痛加剧，气肿范围扩大。担心发生坏死性筋膜炎。进行了手术探查并开始高压氧治疗。术中，在左臂发现穿刺痕迹。有明显气体逸出，但发现正常、未受影响的组织，微生物培养结果为阴性。我们观察到良好的临床转归。缺乏明显病因、不明穿刺痕迹以及精神疾病合并症提示可能是人为操作导致的皮下气肿。临床稳定、疼痛轻微且无明显炎症变化的皮下气肿患者可采用保守治疗。密切的临床监测对于避免在发生坏死性软组织感染时延迟干预至关重要。
