Subcutaneous emphysema occurs when air gets into tissues under the skin. This usually occurs in the skin covering the chest wall or neck, but can also occur in other parts of the body. Subcutaneous emphysema is characterized by painless swelling of the tissues because of air tracking along tissue planes. It is commonly seen over the chest wall around drain sites, in the head and neck. Palpation elicits a characteristic tissue paper feeling beneath the fingers.

Subcutaneous emphysema (SE) is a condition often causing minimal symptoms, but sometimes it can be severe and even life-threatening. This study is the first great survey about SE. The aim of this study is to classify and evaluate the etiology, signs, symptoms, and management of SE.

A man aged 71 with severe chronic obstructive pulmonary disease who had suffered recurrent right-sided pneumothoraces was admitted to a district general hospital for elective pleurectomy and apical bullectomy. The procedure was performed thoracoscopically and was uneventful; an area of bullous emphysema was identified in the right upper lobe and was stapled and excised. Postoperatively, the patient was noted to have a continuous air-leak and was maintained on 5 kPa of thoracic suction via apical and basal intercostal drains. Chest radiography showed a 10% pneumothorax. Subcutaneous emphysema of the thorax and neck was noted, but it was causing no symptoms. However, over the next two days, the subcutaneous emphysema worsened, involving the face, arms and abdomen. Despite an increase in the suction to 10 kPa, the patient was uncomfortable and had an obvious rise in the pitch of his voice.