Spontaneous Subcutaneous Emphysema of the Neck and Mediastinum

Spontaneous emphysema of the neck

“…The etiologies for free air in the neck are numerous and range from facial trauma to rectal biopsy (Steffey and Conn, 1974), but probably the most common causes are casual and surgical trauma involving the aero-digestive tract In 1850, Knott described a patient who developed subcutaneous emphysema following a bout of violent coughing (Hunsicker et al, 1977). Hammon (1939) reported nine cases of spontaneous emphysema in the neck, and Macklin and Macklin (1944) discussed in detail the pathogenesis of spontaneous pneumomediastinum.…”

“…The causes of increased intra-alveolar pressure are numerous, but the commonest of diem are aspiration of the new bora and asthma (Thawley, 1974) especially in older asthmatic children who have a long history of the disease (Ozonoff, 1965). Other causes are measles (Amin et at, 1972), violent coughing (Hunsicker et al, 1977), whooping cough (McNicholl, 1960), endotracheal anaesthesia (Thawley, 1974), the use of high pressure ventilators (Hunsicker et al, 1977) and occasionally the Valsalva maneuver (Agarwal, 1979).…”

“…The air may extend to the pericardium, causing pneumo-pericardium, which can be recognized clinically by a systolic crushing sound (Hammon's(1939) sign), which has been noted in 50 per cent of patients with pneumo-mediastinum (Gray and Hanson, 1966). Rupture of the air to the pleural cavity may cause collapse of the lung, with the additional hazard of tension pneumothorax (Hunsicker et al, 1977), which may be bilateral (Steffey and Cohn, 1974;Agarwal, 1979). It is possible that, if the air volume in the pneumo-mediastinum is high enough, it may compress the great vessels in the chest, causing heart failure (Hunsicker et aL, 1977).…”

Spontaneous laryngeal emphysema

“…Spontaneous subcutaneous emphysema may also involve the mediastinum. This complication results from penetrating trauma, endoscopic procedures such as direct laryngoscopy, bronchoscopy, esophagoscopy, mediastinoscopy or tracheostomy, particularly in children (Hunsicker et al, 1977).…”

“…In 1850 Knott (as quoted by Hunsicker et al, 1977) described a patient who developed subcutaneous emphysema following a violent coughing fit. Since that time various cases of this condition have been reported.…”