title: Managing iatrogenic subcutaneous emphysema on a background of COPD while treating persistent secondary pneumothorax.
abstract: This is a case of a 77-year-old gentleman with severe smoking related chronic obstructive airways disease (COPD) who presented with a secondary pneumothorax. Attempts to treat a persistent air leak using (IC) drains of increasing size led to sudden worsening of iatrogenic subcutaneous emphysema. A CT scan performed confirmed the presence of a pneumomediastium and florid subcutaneous emphysema in the face and torso. Although the patient reported a change in voice with hoarseness there was no evidence of airway compromise. The patient was conservatively managed in the high-dependency unit. He was not considered fit enough to undergo general anaesthesia and surgery; therefore, a pleurodesis using sterile talc was undertaken. The IC drain was successfully removed, following resolution of the air leak, and the lung remained re-inflated. His subcutaneous emphysema gradually spontaneously resolved with no further complications.
authors: Respiratory Department, NHS, Sussex, UK. lynettelow@doctors.org.uk
authors: Lynette
authors: L
authors: Low
authors: Nicholas
authors: N
authors: Adams
mesh_terms: D000368:Aged; D002908:Chronic Disease; D004322:Drainage / Q000009:adverse effects* / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D018700:Pleurodesis / Q000379:methods; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D013902:Radiography, Thoracic / Q000379:methods; D018570:Risk Assessment; D012720:Severity of Illness Index; D013352:Subcutaneous Emphysema / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome