Letter to the Editor
Treatment of Severe Subcutaneous Emphysema by Microdrainage. A Case Report
Tratamiento de enfisema subcutáneo severo por microdrenaje. A propósito de un caso
Kevin Gustavo Alarcón-Meregildo, Francisco Javier Polo-Romero
, Jose Luis Beato-Pérez
Corresponding author
Servicio de Medicina Interna, Hospital de Hellín, Hellín, Albacete, Spain
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A Case Report" "tieneTextoCompleto" => true "saludo" => "To the Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "47" "paginaFinal" => "48" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Kevin Gustavo Alarcón-Meregildo, Francisco Javier Polo-Romero, Jose Luis Beato-Pérez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Kevin Gustavo" "apellidos" => "Alarcón-Meregildo" ] 1 => array:4 [ "nombre" => "Francisco Javier" "apellidos" => "Polo-Romero" "email" => array:1 [ 0 => "fpolo1111@yahoo.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 2 => array:2 [ "nombre" => "Jose Luis" "apellidos" => "Beato-Pérez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Medicina Interna, Hospital de Hellín, Hellín, Albacete, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tratamiento de enfisema subcutáneo severo por microdrenaje. A propósito de un caso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 750 "Ancho" => 1000 "Tamanyo" => 109009 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Severe subcutaneous emphysema. Fenestrated catheters placed according to the technique described by Beck, connected to continuous aspiration.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Subcutaneous emphysema (SE) is defined as tumefaction produced by the presence of air or gas in the skin.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It is a primarily aesthetic problem which does not usually cause complications, unless it is very extensive. We present a case of severe SE due to iatrogenic pneumothorax treated with a fenestrated angiocatheter, according to the method described by Beck,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> used for the first time in our centre.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 77-year-old male, with a history of GOLD stage III COPD, was admitted for percutaneous pulmonary biopsy for the study of a lung nodule suggestive of bronchogenic carcinoma. After the procedure, pneumothorax was detected, requiring the placement of a drainage tube which was only maintained for 24<span class="elsevierStyleHsp" style=""></span>h before it was accidentally removed. The patient subsequently developed extensive SE (face, neck, upper and lower limbs) and reappearance of the pneumothorax. A new drainage tube with aspiration was placed, resolving the pneumothorax, but not the SE. The decision was taken to withdraw the chest drainage and continue with conservative treatment. However, the SE progressed, causing dyspnoea and difficulty seeing and swallowing, so treatment was initiated with a fenestrated angiocatheter, according to the technique described by Beck,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> consisting of several fenestrations made in a spiral pattern along a 14G-calibre angiocatheter. Two fenestrated catheters were inserted in the subcutaneous space, 2<span class="elsevierStyleHsp" style=""></span>cm lateral the midclavicular line at the level of the third rib (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), achieving immediate improvement after placement. It was connected to continuous suction and the nursing staff and family members were instructed in performing massage manoeuvres from the distal to the medial regions to facilitate aspiration. In less than 48<span class="elsevierStyleHsp" style=""></span>h, the patient could open his eyes and his dyspnoea had resolved. He was discharged after resolution of symptoms.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Studies on the mechanism of pulmonary interstitial emphysema, pneumomediastinum and SE have shown that air begins to migrate from a rupture in the alveoli to the pulmonary interstitial tissue and then on to the perivascular space until it reaches the mediastinum.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> When the passage of air is greater than the pleural resorption, SE occurs. This may also develop in the case of SE due to iatrogenic pneumothorax. Serious complications have been described, such as pacemaker malfunction, compromised airway, intracranial hypertension or respiratory failure, but these are uncommon. Conservative management is generally sufficient for the resolution of SE,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> although several therapies have been proposed, such as making holes in the skin, placement of chest tubes, pig-tail drainage or trocar drainage, all of which have limited use and are associated with risks of infection, scarring and patient discomfort.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Fenestrated catheter placement is easy, fast and simple and is minimally invasive, since the risks of infection and skin scarring are reduced, although its use for periods longer than 72<span class="elsevierStyleHsp" style=""></span>h is not recommended.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> This technique for the management of SE must be used on an individualised basis, depending on the clinical context and severity of the symptoms, although its ease of use, high effectiveness, low cost, minimal invasiveness and low risk of complications make it a good option in selected cases.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Alarcón-Meregildo KG, Polo-Romero FJ, Beato-Pérez JL. Tratamiento de enfisema subcutáneo severo por microdrenaje. A propósito de un caso. Arch Bronconeumol. 2014;50:47–48.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 750 "Ancho" => 1000 "Tamanyo" => 109009 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Severe subcutaneous emphysema. Fenestrated catheters placed according to the technique described by Beck, connected to continuous aspiration.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tratamiento conservador del enfisema subcutáneo y neumomediastino" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.J. Rivares Esteban" 1 => "P.J. Gil Paraíso" 2 => "M.A. García Martín" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "ORL Aragón" "fecha" => "2001" "volumen" => "4" "paginaInicial" => "17" "paginaFinal" => "19" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Simple construction of a subcutaneous catheter for treatment of severe subcutaneous emphysema" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P.L. Beck" 1 => "S.J. Heitman" 2 => "C.H. Mody" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2002" "volumen" => "121" "paginaInicial" => "647" "paginaFinal" => "649" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11834684" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Massive spontaneous subcutaneous emphysema. Acute management with infraclavicular ‘blow holes’" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D.B. Herlan" 1 => "R.J. Landreneau" 2 => "P.F. Ferson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "1992" "volumen" => "102" "paginaInicial" => "503" "paginaFinal" => "505" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1340766" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy of microdrainage in severe subcutaneous emphysema" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F. Leo" 1 => "P. Solli" 2 => "G. Veronesi" 3 => "L. Spaggiari" 4 => "U. Pastorino" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2002" "volumen" => "122" "paginaInicial" => "1498" "paginaFinal" => "1499" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12377896" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005000000001/v1_201402160026/S1579212913002085/v1_201402160026/en/main.assets" "Apartado" => array:4 [ "identificador" => "14576" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005000000001/v1_201402160026/S1579212913002085/v1_201402160026/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212913002085?idApp=UINPBA00003Z" ]
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| 2017 July | 77 | 8 | 85 |
| 2017 June | 79 | 15 | 94 |
| 2017 May | 90 | 3 | 93 |
| 2017 April | 125 | 8 | 133 |
| 2017 March | 86 | 12 | 98 |
| 2017 February | 55 | 2 | 57 |
| 2017 January | 78 | 3 | 81 |
| 2016 December | 71 | 13 | 84 |
| 2016 November | 138 | 22 | 160 |
| 2016 October | 146 | 20 | 166 |
| 2016 September | 484 | 12 | 496 |
| 2016 August | 182 | 25 | 207 |
| 2016 July | 91 | 27 | 118 |
| 2016 March | 2 | 0 | 2 |
| 2016 February | 1 | 0 | 1 |
| 2015 December | 3 | 0 | 3 |
| 2015 October | 86 | 2 | 88 |
| 2015 September | 78 | 23 | 101 |
| 2015 August | 53 | 26 | 79 |
| 2015 July | 128 | 32 | 160 |
| 2015 June | 71 | 19 | 90 |
| 2015 May | 80 | 27 | 107 |
| 2015 April | 64 | 32 | 96 |
| 2015 March | 90 | 17 | 107 |
| 2015 February | 110 | 12 | 122 |
| 2015 January | 53 | 16 | 69 |
| 2014 December | 53 | 15 | 68 |
| 2014 November | 73 | 11 | 84 |
| 2014 October | 95 | 25 | 120 |
| 2014 September | 60 | 15 | 75 |
| 2014 August | 47 | 10 | 57 |
| 2014 July | 51 | 13 | 64 |
| 2014 June | 68 | 18 | 86 |
| 2014 May | 33 | 7 | 40 |
| 2014 April | 38 | 15 | 53 |
| 2014 February | 0 | 2 | 2 |
Show all
