Orris
attachment
attachment

Diagnosis?

Reading File
analyse_media
Finding Sources
Searching PubMed

subcutaneous emphysema AND computed tomography

Searching the Web

subcutaneous emphysema CT causes evaluation review

This single CT screenshot appears to show extensive subcutaneous emphysema, meaning air trapped in the soft tissues of the chest wall/neck. The streaky dark pockets of air in the anterior chest wall are the key feature.
I cannot determine the cause or make a definitive diagnosis from one photographed CT slice. Causes can include pneumothorax or pneumomediastinum, chest trauma, recent surgery/procedure, airway or esophageal injury, and, if there is no such history, occasionally a serious gas-forming soft-tissue infection. Air can enter chest-wall tissues from the lung or tracheobronchial tree, as described in Tintinalli's Emergency Medicine, section “Subcutaneous Emphysema.”
Urgent assessment is needed now if there is breathlessness, chest pain, voice change, difficulty swallowing, fever, rapidly increasing swelling, severe skin pain, or low oxygen levels. Please obtain the formal CT radiology report and have the treating emergency/chest-surgery team review the full scan.

Explain each part

Reading File
analyse_media
Finding Sources
Searching PubMed

subcutaneous emphysema AND pneumomediastinum

Searching the Web

pneumomediastinum subcutaneous emphysema evaluation causes clinical review

This is a sagittal CT image, a side-view slice through the upper chest and lower neck. In CT images:
  • White = dense material, mainly bone or injected contrast in blood vessels
  • Gray = soft tissue, muscle, heart, blood vessels
  • Black = air, normally in the lung or airway
  • The “10 cm” marker at right is the size scale
  • “Contrast” means intravenous contrast was given, so blood vessels look bright.

What is visible

  1. Front of the body
    • The right side of this picture is likely the front chest wall.
    • You can see skin, fat, and chest-wall muscle as gray layers.
  2. Air in the chest-wall tissues
    • The multiple irregular black streaks and bubbles within the gray chest-wall tissue are not normal lung.
    • They are most consistent with subcutaneous emphysema: air beneath the skin and between muscle/fascial planes.
    • The air appears to extend upward toward the lower neck.
  3. Lung
    • The large black region behind the chest wall is mostly aerated lung, which is normally black on CT.
    • A single screenshot cannot reliably show whether there is a pneumothorax, lung collapse, contusion, or another lung cause. The full CT series is required.
  4. Ribs and spine
    • The bright curved/oval structures around the edge of the chest are ribs seen in cross-section.
    • The larger bright bony structure toward the lower right is part of the thoracic spine/vertebra.
  5. Central chest structures
    • The bright gray-white rounded structures in the center/lower image are contrast-filled major blood vessels and heart-related structures.
    • Exact identification is limited by this being a single, angled photo of a CT screen.

What the finding means

Subcutaneous emphysema is a finding, not the underlying diagnosis by itself. Air has escaped from somewhere and tracked through soft tissues. Common contexts include:
  • Chest injury or rib fracture with an associated lung injury
  • Pneumothorax, meaning air outside the lung
  • Pneumomediastinum, meaning air in the central chest
  • Recent chest surgery, chest tube, intubation, or other procedure
  • Less commonly, injury to the trachea, bronchi, or esophagus
  • Rarely, a serious gas-forming infection, particularly when there is fever, marked pain, redness, or rapidly worsening swelling.
Air in the mediastinum can spread outward into the subcutaneous tissues; trauma and esophageal/chest injury are recognized causes of both conditions in this NIH case review.

What cannot be concluded from this photo

I cannot diagnose the source of the air, determine severity, or exclude urgent complications from this one image. The formal radiology report should specifically address:
  • Pneumothorax
  • Pneumomediastinum
  • Rib/sternal fractures
  • Lung laceration or contusion
  • Tracheal, bronchial, or esophageal injury
  • Progression compared with prior imaging
Seek urgent in-person care immediately if there is worsening breathlessness, chest pain, neck/facial swelling, voice change, trouble swallowing, fever, confusion, or low oxygen.
This is a shared conversation. Sign in to Orris to start your own chat.