Abnormal soft tissues

Published on 23/05/2015 by admin

Filed under Internal Medicine

Last modified 22/04/2025

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CHAPTER 10 Abnormal soft tissues

Surgical emphysema 150

Surgical emphysema

This is the film of a young asthmatic patient who presented with chest pain. The film was taken to look for complications of asthma such as a pneumothorax or air in the mediastinum – pneumomediastinum. Neither can be seen, but there is extensive air in the soft tissues (arrows) over her shoulders and along the right chest wall, best seen in the axillary area. There probably is a small pneumothorax, but this cannot be seen on the film.

At first sight surgical emphysema gives a very messy appearance which is sometimes confined to the obvious soft tissue areas but may spread over the whole X-ray. If you suspect surgical emphysema look for the following characteristics:

1. In mild cases look for lozenge-shaped areas of blackness which represent pockets of air in the soft tissue. These areas will all lie in the same plane which will follow the plane of the soft tissue structures.

2. In severe cases the orientation of the planes is lost. Instead look for alternating dark and white lines which appear not to be confined to single structures and cross part or all of the film.

Causes of surgical emphysema

Iatrogenic, e.g. surgery, chest drain insertion

Obstructive lung disease, e.g. asthma

Oesophageal injury

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