Spinning surgical emphysema

[Timothy J Coats (SURG) 7728]

> 
> The question:
> in patients with blunt chest trauma, is the presence of surgical
> emphysema, pathognomic of pneumothorax??
> 
> Has anyone seen lateral emphysema without a PNX?
> 

Nothing in medicine is 100%. I can remember 1 patient with lateral 
and 1 patient with central surgical emphysema who had normal 
chest scans and we never found out where their airway was 
damaged (there were no external wounds through which air could 
become sucutaneous and the patient with central emphysema had 
a normal bronchoscopy).

However the association between surgical empysema and 
underlying pneumothorax is so strong that I would always be 
confident to put in a chest drain without an Xray (which might be 
normal anyway if there is an anterior pneumothorax).

Tim.

Timothy J Coats MD FRCS FFAEM
Senior Lecturer in Accident and Emergency / Pre-Hospital Care
Royal London Hospital, UK.