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BMJ Case Rep. 2010; 2010: bcr0920092283.
Published online Aug 16, 2010. doi:  10.1136/bcr.09.2009.2283
PMCID: PMC3030005
Reminder of important clinical lesson
Managing iatrogenic subcutaneous emphysema on a background of COPD while treating persistent secondary pneumothorax
Lynette Low and Nicholas Adams
Respiratory Department, NHS, Sussex, UK
Correspondence to Lynette Low, lynettelow/at/doctors.org.uk
Abstract
This is a case of a 77-year-old gentleman with severe smoking related chronic obstructive airways disease (COPD) who presented with a secondary pneumothorax. Attempts to treat a persistent air leak using (IC) drains of increasing size led to sudden worsening of iatrogenic subcutaneous emphysema. A CT scan performed confirmed the presence of a pneumomediastium and florid subcutaneous emphysema in the face and torso. Although the patient reported a change in voice with hoarseness there was no evidence of airway compromise. The patient was conservatively managed in the high-dependency unit. He was not considered fit enough to undergo general anaesthesia and surgery; therefore, a pleurodesis using sterile talc was undertaken. The IC drain was successfully removed, following resolution of the air leak, and the lung remained re-inflated. His subcutaneous emphysema gradually spontaneously resolved with no further complications.
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