1. Dilemma in some cases of
Surgical emphysema
• Many times such a
situation is confronted in
accident and emergency
department .

3. PECULIAR SITUATION
• Sometime there is a situation
where there is significant
traumatic surgical
emphysema with no clinical
S/S of pneumothorax or
haemo -thorax or rib fracture.

5. DILEMMA IS
• .Dilemma is what is the
cause of this surgical
emphysema where X ray
chest and USG of chest
findings are also equivocal.

6. MEDICOLEGAL ASPECT
• From medico legal point of
view also it is necessary to
find out the cause(when pt.
complain of assault) and also
from further treatment point
of view .

7. CASE -1 IN LITERATURE
• By going through the literature ,
an article speaks about 2 cases
of this nature. Case No1 : Here
there was no rib fracture ,
pneumothorax or haemo thorax
on Ches X ray. CT Scan revealed
pneumo mediastinum.

8. CASE NO -2
• Case No 2: This patient had
similar findings and the other
party complained that the
treating doctor has injected air in
subcutaneous plane to make
injury to be dangerous in nature
• Referance: IIJFMT 4(1) 2006

9. CASE NO-3
• Diffuse subcutaneous emphysema,
pneumomediastinum, and pneumothorax
after dental extraction.
• Ann Emerg Med. 1993 Feb;22(2):248-50.
• We present a case of subcutaneous
emphysema, pneumomediastinum,
pneumothorax, and pneumoretroperitoneum
after a dental procedure with an air-and-
water-cooled turbine burr drill.

10. CASE --3

11. NEEDS MORE EXPERIMENTATION
• Ultimately experts opined that
injury was traumatic and not
iatrogenic. But in cadaver , surgical
emphysema could be produced by
injecting air with syringe. But it was
observed that in living human
beings this is to be experimented
further.

12. HOW TO TACKLE?
• The situation can be handled by
taking following points in to
consideration:
• 1. We should be careful in such
cases. Look for any needle
puncture point on chest wall.

13. CONTINUED----
• 2. If X ray chest is normal, CT
Scan may be helpful. If CT is
inconclusive then MRI may be
got done to locate pneumo
mediastinum. Both are
inconclusive then abdominal
cavity may be attended.

14. • 3. Intercostal tube for drainage
should be used for treatment
selectively only if respiratory
distress is there.
• 4. Multiple incisions in skin over
chest may relieve the symptoms.

15. •THANKS