Samlaska C P, Maggio K L
Dermatology Service, Walter Reed Army Medical Center, Washington, DC, USA.
Adv Dermatol. 1996;11:117-51; discussion 152.
A medical emergency, the detection of subcutaneous emphysema requires thorough evaluation to exclude the multitude of disease processes that may demonstrate this clinical finding. Gas gangrene must be considered in the differential diagnosis of all forms of subcutaneous emphysema and infections with some species, such as C. novyi, may not produce gas at all. Isolation of C. septicum from the blood is almost always associated with colon cancer or hematologic malignancies. Nonclostridial gas gangrene in diabetic patients is indistinguishable clinically from clostridial gas gangrene. A unique and true dermatologic emergency is the detection of nontraumatic subcutaneous emphysema of the thigh with or without associated erythema, tenderness, or bullous lesions. This finding is associated with perforated viscus in a retroperitoneal location. Infections with gas-producing organisms continue to be a source of significant morbidity in modern times.
作为一种医疗急症，皮下气肿的检测需要进行全面评估，以排除可能出现这一临床发现的众多疾病过程。在所有形式的皮下气肿的鉴别诊断中都必须考虑气性坏疽，并且某些菌种（如诺维梭菌）感染可能根本不产生气体。从血液中分离出败血梭菌几乎总是与结肠癌或血液系统恶性肿瘤相关。糖尿病患者的非梭菌性气性坏疽在临床上与梭菌性气性坏疽无法区分。一种独特且真正的皮肤科急症是检测到大腿部有无创伤性皮下气肿，伴或不伴有相关的红斑、压痛或大疱性病变。这一发现与腹膜后位置的脏器穿孔有关。产气微生物感染在现代仍然是导致严重发病的一个原因。
