Subcutaneous emphysema: ultrasound barrier

Perioperative care with an ultrasound device is as Michael Jordan with Scotty Pippen: at its best!

“…Furthermore, their findings on subcutaneous emphysema confirm that, because a natural barrier is formed due to acoustic impedance between aqueous tissue and migrated air, that occludes the scattering of ultrasound signals, the composition of an ultrasound image is impossible. This is in concordance with the literature, yet they also showed that in cases with only limited amounts of subcutaneous emphysema, this problem can easily be solved by adjusting probe position (16,17).…”

Subcutaneous emphysema and ultrasound sonography

“…Moreover, sonography enables us to confirm the site of puncture for monitoring the spatial relationships between the venous and the needle during the puncture through the real-time imaging [ 6 ]. One of the important factors for complicating the ultrasound-guided central venous catheterization is subcutaneous emphysema as ultrasound barrier [ 7 ]. Absolute difference of acoustic impedance between the aqueous tissue and migrated air causing emphysema occludes the scattering of ultrasound signals and prevents from composing the image of deep body structures.…”

“…Absolute difference of acoustic impedance between the aqueous tissue and migrated air causing emphysema occludes the scattering of ultrasound signals and prevents from composing the image of deep body structures. Verniquet and Katel [ 7 ] reported the scanning image of the patient with subcutaneous emphysema; however, there is scarce information of the ultrasound images in a literature for the patient with subcutaneous emphysema.…”

Extensive subcutaneous emphysema following lobectomy

“…The distance from the skin to the chest wall was 10 cm, longer than an average finger, in addition to intercostal space narrowing commonly seen after thoracic surgical procedures.14 Furthermore, the tissue–air interface in subcutaneous emphysema acts as a barrier to ultrasound due to the large difference in acoustic impedance, preventing bedside ultrasound use. 15 We avoided the use of trocar-type chest tubes due to reported complications 16 , 17 and inserted a Seldinger drain into the triangle of safety, bordered by the lateral border of pectoralis major, anterior border of latissimus dorsi apex of the axilla and a horizontal line extending from the nipple. 18 The CT provided assurance of the puncture site showing no internal structures nearby.…”