Subcutaneous Emphysema: An Outlandish Hint to an Impacted Tracheobronchial Foreign Body
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CLINICAL REPORT
Subcutaneous Emphysema: An Outlandish Hint to an Impacted Tracheobronchial Foreign Body Ritika Bhatia1 • Vikas Gupta1 • Deepankar Malik1 • Kiran Upadhyay1 N. Madhav Reddy1 • Anchita Srivastava1
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Received: 30 August 2020 / Accepted: 7 October 2020 Ó Association of Otolaryngologists of India 2020
Abstract Tracheobronchial foreign body aspiration amongst paediatric population is one of the commonest challenges faced by the otolaryngologist. Subcutaneous emphysema is an uncommon presentation of this condition and the ENT specialist needs to have a high index of clinical suspicion of a foreign body. We report a case of 2-year old child presented with subcutaneous emphysema later diagnosed with a foreign body in the bronchus.
scenario and only few case reports have been published till now [3]. We report a case of foreign body aspiration by a 2-year old child presenting with features of subcutaneous emphysema.
Keywords Tracheobronchial foreign body Subcutaneous emphysema Spontaneous pneumomediastinum
2 years old male child presented to the paediatrician with complaints of swelling of the upper chest bilaterally (left more than right) shoulder and neck along with tachypnea of 03 days duration which was acute in onset and progressive. There was a history of dry cough of one-month duration, without any diurnal variation. There was no history of fever, haemoptysis, noisy breathing or cyanosis. As per mother, there was no evident history of any foreign body aspiration or trauma. Prenatal, postnatal, developmental history were non-contributory. On examination, child was conscious, tachypneic, however child was maintaining oxygen saturation of 92% on room air. There was diffuse, reducible, non-tender swelling over bilateral chest (left more than right) with crepitus on palpation (Fig. 1). Auscultation revealed bilateral decreased air entry right more than left lung with no wheeze. Rest of examination was normal. CXR PA view showed subcutaneous emphysema bilaterally with pneumomediatinum and tension pneumothorax on left causing mediastinal shift to right side (Fig. 2). The patient was provisionally diagnosed as bronchopneumonia with subcutaneous emphysema and started on IV antibiotics and oxygen. However, patient started desaturating the next day and underwent emergency intercostal drain (ICD) insertion by paediatric surgeon. Despite ICD insertion, patient did not maintain oxygen saturation at
Introduction Tracheobronchial foreign body (FB) aspiration is a common emergency in children between 1 and 3 years of age [1, 2]. Most of the accidentally inhaled foreign body are vegetative like peanuts, seeds etc. Immediate impaction of FB in the upper airways may have tell-tale signs like stridor, choking, gagging or wheezing thereby raising a strong suspicion. However, impaction in the lower airways may be minimally symptomatic or even asymptomatic for long time till it becomes complicated, mostly with secondary infection or rarely with presentation like subcutaneous emphysema (SCE) or spontaneous pneumomedi
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