Subcutaneous Emphysema: Signs, Symptoms, Causes, Diagnosis, Treatment and Prevention

It is a disorder in which air bubbles are trapped under the skin.

The condition can occur after surgery or a traumatic accident and can also develop locally in cases of gas gangrene.

Signs and symptoms

The signs and symptoms of subcutaneous emphysema vary depending on the cause but can be pretty asymptomatic and include the following:

  • Neck swelling and chest pain.
  • It can also have a sore throat or tonsillitis.
  • Neck Pain.
  • Difficulty in swallowing.
  • Wheezing and shortness of breath
  • When touching the skin that covers it, it feels like a tissue or Rice Krispies and can cause a cracking noise when gas is pushed into the tissue. Air bubbles are painless and feel like little nodules that are soft to the touch.
  • The tissue surrounding subcutaneous emphysema is often inflamed.
  • The face can also swell if the level of air leakage in the tissues is high.
  • When subcutaneous emphysema is around the neck, there may be a feeling of fullness around the neck, and the voice may also change.
  • Inflammation can also occur in other body parts other than the neck and chest region. For example, you may experience swelling in features such as the abdomen and extremities as there are no gaps in the fatty tissue of the skin to restrict air movement.
  • Chest X-rays can also show air in the middle of the chest cavity.


Subcutaneous emphysema is a rare condition, and when it does occur, some of the possible causes include the following:

  • Chest trauma is one of the leading causes of subcutaneous emphysema, which causes air to enter the skin in the chest through the lung or neck. 
  • When the pleural membranes rupture, as occurs during penetrating chest trauma, air can pass from the lungs to the muscles and subcutaneous tissue of the chest wall.

When the alveoli of the lung are ruptured, as in a lung laceration, air can travel below the lining of the lung, the visceral pleura, the hilum of the lung, higher up to the trachea and then to the neck and neck. Chest wall.

Rib fractures can also tear the membrane that lines the inside of the chest wall, the parietal pleura, and thus allow air to escape into the subcutaneous tissues.

Trauma to the chest can be caused by accidents, gunshot wounds, stab wounds, or chest injuries from being struck with a blunt object.


Other common causes include:

  • During asthma attacks.
  • During the delivery.
  • During dental surgery, through the use of high-speed air-propelled tools, although this occurs infrequently, it can lead to swelling in the neck and face, as well as the appearance of the typical creaking of subcutaneous emphysema.
  • When using the Heimlich maneuver, the Heimlich maneuver is a first-aid procedure consisting of abdominal thrusts intended to displace objects obstructing the tracheal airway.
  • Excessive pressure, also known as barotrauma, such as that experienced during diving, damages the lungs and allows air to escape into the chest.
  • Hamman’s syndrome can result from several factors, one of which is the aspiration of a foreign body, where the inhaled object punctures the airways or increases the pressure within the damaged lung significantly to cause them to explode and allow air to escape into the woven environment.
  • Fracture of the facial bones.
  • Snorting cocaine.
  • Corrosive or chemical burns to the esophagus.
  • Whooping cough, also known as whooping cough.
  • Intense vomiting is also known as Boerhaave syndrome.
  • Specific medical procedures involve inserting a tube into the body, such as endotracheal intubation, where a line is placed into the throat and windpipe through the mouth and nose, and bronchoscopy, where a tube is placed into the bronchi through the mouth.
  • Necrotizing infections can also cause air to be trapped within the skin, and conditions such as gas gangrene cause subcutaneous emphysema.
  • Activities like scuba diving can also draw air into the subcutaneous tissue.
  • Tension pneumothorax is where, after an injury, air accumulates outside the lung within the thoracic cavity and exerts pressure on the organs within the thorax, increasing the possible entry of air into the subcutaneous tissue through a pleura torn by a broken rib.


The diagnosis of prominent cases of subcutaneous emphysema is quite simple due to its characteristic symptoms. However, in some cases, the signs are very subtle, making diagnosing the disorder difficult.

Medical imaging procedures are used to diagnose the presence of subcutaneous emphysema or to confirm a diagnosis made using various clinical signs.

Subcutaneous emphysema is visible on a chest radiograph as radiolucent striae arranged in the most extensive pectoral muscle group pattern. Air in the subcutaneous tissues can make it challenging to detect severe conditions such as pneumothorax during a chest X-ray.

The effectiveness of a chest ultrasound can also be decreased due to this air. However, the fact that tissue emphysema is usually detected on a chest radiograph before a pneumothorax becomes apparent can be used to deduce the presence of the latter condition.

CT scans are also used to diagnose subcutaneous emphysema. Air pockets caused by SE appear as dark spots on a CT scan.


Subcutaneous emphysema is usually benign and does not need treatment; however, if the amount of air trapped in the subcutaneous tissue is large, it can cause discomfort and shortness of breath.

This, therefore, may justify the reasons for the treatment. Some of the ways to treat subcutaneous emphysema include:

  • Surgical drainage can be performed mainly when the air expelled from the lung causes pressure that prevents blood flow to the breast’s areola and the skin of the labia majora or scrotum.
  • For severe subcutaneous emphysema, catheters can be placed in the subcutaneous tissue to release air
  • Minor cuts, known as ” blow holes,” can also be made in the skin to release the gas.
  • Rest in bed, taking medication to control pain, and taking supplemental oxygen are all means of treating subcutaneous emphysema. Breathing oxygen can help the body absorb subcutaneous air more quickly.
  • When subcutaneous emphysema is caused by pneumothorax, the air outside the lung that causes pressure on the chest organs, a tube can be inserted into the chest to pump air through suction.

Subcutaneous emphysema healing time

The time required for subcutaneous emphysema to heal completely depends on its duration, severity, and underlying causes. In some cases, SE goes away on its own after a while, while in others, it requires treatment. Therefore, the duration of the condition can vary significantly from one person to another.


There are no known ways to prevent subcutaneous emphysema. Scientists are trying to discover preventive methods that can decrease the chances of developing subcutaneous emphysema.

Eating a balanced diet that contains antioxidants in large amounts helps improve lung function. This can help an individual avoid the condition.


A rare complication of using a chest tube to treat subcutaneous emphysema is tracheobronchial laceration.

This potentially serious condition can occur due to uneventful and difficult intubations. In most cases, lacerations occur longitudinally on the posterior membranous wall of the trachea or where the cartilaginous ring joins the membranous wall.

Subcutaneous emphysema can also cause the following complications if left untreated:

  • Airway compromise.
  • Respiratory tract failure.
  • Internal tension in the body.


Subcutaneous emphysema is not a life-threatening condition and does not pose a severe threat to a patient. In general, the prognosis is favorable with treatment. The body absorbs small amounts of this air.

Subcutaneous emphysema usually goes away once the pneumomediastinum or pneumothorax causes the problem to be treated appropriately. However, a spontaneous Tissue Emphysema can progress to a life-threatening condition in some rare cases.

Subcutaneous emphysema caused by mechanical ventilation can induce ventilatory failure.