Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Jodhpur, India.
J Forensic Sci. 2022 Sep;67(5):2106-2109. doi: 10.1111/1556-4029.15078. Epub 2022 Jun 14.
Subcutaneous emphysema can be traumatic, infectious, iatrogenic, or spontaneous. Traumatic subcutaneous emphysema of the upper limb is not infrequent following trauma to that limb. However, the subcutaneous emphysema of the limbs following trauma to a site other than the limb is seldom reported. A 45-year-old male was referred from a private hospital to a tertiary care hospital with right-sided multiple rib fractures and pneumothorax following chest injury. The patient was having acidotic breathing on examination, and crepitus was present over the bilateral chest and bilateral upper and lower limbs, suggesting subcutaneous emphysema. Right and left intercostal drainage tubes were inserted at our hospital. The patient died in the emergency after a few hours of treatment. The X-ray performed at the autopsy revealed extensive bilateral upper and lower limb subcutaneous emphysema. The deceased had multiple rib fractures over the right side with fractured ends of the two ribs piercing the pleural cavity, causing tears in the lung parenchyma. The cause of death was attributed to the chest injury and its sequelae. Such rapidly expanding subcutaneous emphysema can be a sign of underlying severe chest injury. Prompt insertion of the intercostal drainage tube could be the lifesaving procedure in such cases.
皮下气肿可由创伤、感染、医源性或自发性因素引起。上肢创伤后常发生创伤性皮下气肿，但创伤部位不在肢体的肢体皮下气肿则很少见。一名 45 岁男性因胸部外伤导致右侧多发性肋骨骨折和气胸，从一家私立医院转至一家三级保健医院。检查时患者呼吸呈酸中毒，双侧胸部和双侧上下肢均有捻发音，提示皮下气肿。在我院插入右、左肋间引流管。治疗数小时后，患者在急诊室死亡。尸检时拍摄的 X 光片显示广泛的双侧上下肢皮下气肿。死者右侧有多处肋骨骨折，两根肋骨的骨折端刺穿胸腔，导致肺实质撕裂。死因归因于胸部损伤及其后遗症。如此迅速扩展的皮下气肿可能是严重胸部损伤的迹象。在这种情况下，及时插入肋间引流管可能是救命的程序。
