The n e w e ng l a n d j o u r na l of m e dic i n e

Images in Clinical Medicine

Chana A. Sacks, M.D., Editor

Crepitus and Subcutaneous Emphysema

A
n 86-year-old woman with a history of severe emphysema pre- Yehia Saleh, M.B., B.Ch.
sented to the emergency department with sudden-onset shortness of Ahmad Alratroot, M.D.
breath. Two weeks earlier, she had been treated for community-acquired Michigan State University
pneumonia that was complicated by a pneumothorax on the right side, leading to East Lansing, MI
the temporary insertion of a chest tube. The drain was removed before the patient yehia.saleh@hc.msu.edu
was discharged, without complication. On examination during the current presen-
tation, the oxygen saturation was 82% while the patient was breathing ambient
air, and breath sounds were diminished in the right hemithorax. Extensive palpable
crepitus could be clearly visualized in the neck (see video). Findings on computed A video is
tomography of the chest included emphysematous changes in the lungs, a moder- available at
ate pneumothorax on the right side, and extensive subcutaneous emphysema. A NEJM.org
chest tube was reinserted; however, the patient’s clinical status continued to dete-
riorate, and ultimately a decision was made to pursue comfort care.
DOI: 10.1056/NEJMicm1907386
Copyright © 2020 Massachusetts Medical Society.

n engl j med 382;1 nejm.org January 2, 2020 e1

The New England Journal of Medicine
Downloaded from nejm.org at TULANE UNIV on January 1, 2020. For personal use only. No other uses without permission.
Copyright © 2020 Massachusetts Medical Society. All rights reserved.