title: High negative pressure subcutaneous suction drain for managing debilitating subcutaneous emphysema secondary to tube thoracostomy for an iatrogenic post computed tomography guided transthoracic needle biopsy pneumothorax: Case report and review of literature.
abstract: BACKGROUND
  Subcutaneous emphysema is a common complication of tube thoracostomy. Though self-limiting, it should be treated when it causes palpebral closure, dyspnea, dysphagia or undue disfigurement resulting in anxiety and distress to the patient.
  
  
  METHODS
  A 72year old man who was a known case of COPD on bronchodilators developed a large pneumothorax and respiratory distress after a CT guided transthoracic lung biopsy done for a lung opacity (approx. 3×3cm) at the right hilar region on Chest X-ray. Within 24h of an urgent tube thoracostomy, patient developed intractable subcutaneous emphysema with closure of palpebral fissure and dyspnea unresponsive to increasing suction on chest tube. A subcutaneous fenestrated drain was placed mid-way between the nipple and clavicle in the mid-clavicular line bilaterally. Continuous negative suction (-150mmHg) resulted in immediate, sustained relief and complete resolution within 5days.
  
  
  CONCLUSIONS
  Extensive and debilitating SE (subcutaneous emphysema) has to be treated promptly to relieve patient discomfort, dysphagia or imminent respiratory compromise. A variety of treatment have been tried including infraclavicular blow-hole incisions, subcutaneous drains +/- negative pressure suction, fenestrated angiocatheters, Vacuum assisted dressings and increasing suction on a pre-existing chest tube. We describe a high negative pressure subcutaneous suction drain which provides immediate and sustained relief in debilitating SE.
  
  
  CONCLUSIONS
  Debilitating subcutaneous emphysema which causes distress, anxiety, palpebral closure, dyspnoea or dysphagia requires intervention. High negative pressure subcutaneous suction drain provides immediate and sustained relief in extensive and debilitating SE.
authors: Department of Surgical Oncology, SMS Medical College and Hospital, JLN Marg, Jaipur, 302004, Rajasthan, India. Electronic address: drzeeshan180@gmail.com.
authors: Zeeshan
authors: Z
authors: Ahmed
authors: Department of Surgical Oncology, SMS Medical College and Hospital, JLN Marg, Jaipur, 302004, Rajasthan, India. Electronic address: drpinakinp@gmail.com.
authors: Pinakin
authors: P
authors: Patel
authors: Department of Surgical Oncology, SMS Medical College and Hospital, JLN Marg, Jaipur, 302004, Rajasthan, India. Electronic address: drsureshsingh@gmail.com.
authors: Suresh
authors: S
authors: Singh
authors: Department of Surgical Oncology, SMS Medical College and Hospital, JLN Marg, Jaipur, 302004, Rajasthan, India. Electronic address: rajgovindsharma@gmail.com.
authors: Raj Govind
authors: RG
authors: Sharma
authors: Department of Surgical Oncology, SMS Medical College and Hospital, JLN Marg, Jaipur, 302004, Rajasthan, India. Electronic address: dr.pankajsomani@yahoo.com.
authors: Pankaj
authors: P
authors: Somani
authors: Department of Surgical Oncology, SMS Medical College and Hospital, JLN Marg, Jaipur, 302004, Rajasthan, India. Electronic address: rauf.mbbs04@gmail.com.
authors: Abdul Rauf
authors: AR
authors: Gouri
authors: Department of Surgical Oncology, SMS Medical College and Hospital, JLN Marg, Jaipur, 302004, Rajasthan, India. Electronic address: meena1989shivsingh@gmail.com.
authors: Shiv
authors: S
authors: Singh
keywords: Case report; Pneumothorax; Subcutaneous emphysema; Tube thoracostmy