Emphysema

Emphysema is the accumulation of air or other gases in the tissues where they are not commonly found. Conditions that increase the volume of air contained in the lungs,see Emphysema.
Mediastinal emphysema - a consequence of the trauma of the chest with damage to respiratory or esophagus (the gap of the trachea, major bronchi, esophagus when penetrating wounds or blunt trauma to the chest, and when endoscopic manipulations, birovni of the esophagus). In these cases, the air when breathing, coughing or swallowing comes in the mediastinum; first, it spreads through the tissue of the heart, then the tissue of the neck, which is clearly revealed by the bulging supraclavicular regions. There may come a compression of large vessels and the mediastinum, which leads to death from cardiovascular disease or asphyxia. In the future, the air may be distributed in the subcutaneous tissue of the chest, at least - of the abdomen and limbs.
Subcutaneous emphysema more likely to occur when exposed to air under the skin of the respiratory or digestive. The ingress of outside air through the wound coverings
sometimes provided that the suction action wounds (for example, penetrating wound of large joints or chest cavity). Signs of subcutaneous emphysema are: diffuse swelling without inflammatory changes similar to swelling, crepitation with the feeling (the crunch of snow).
Emphysema may develop with the formation of gas in the tissues under anaerobic infection (see), Ludwig's angina (see). In this case, emphysema is an important characteristic of development of gas gangrene or gas phlegmon.
The so-called universal emphysema develops with decompression illness (see).
Patients with emphysema need careful monitoring. During increase of the mediastinal emphysema, or distribution of emphysema in the deep tissues of the neck may come compression located there bodies and the development of severe, life-threatening disturbances of activity of cardiovascular system and respiratory organs.
Treatment. Usually subcutaneous emphysema is liquidated without any treatment as resorption air. In the case when the disease can spread rapidly through the tissue of the chest wall on the neck, face and mediastinum, you must drain the pleural cavity on the affected side with the submersible drainage or water suction. Some relief bring small incisions in the skin, subcutaneous tissue and superficial fascia of the neck at the top of the clavicle. Open injuries of the thoracic cavity, accompanied by emphysema, in all cases without exception subject to surgical treatment.
The forecast. Subcutaneous emphysema even with considerable dimensions usually no danger and disappears on its own.
In injuries of the body, causing emphysema, patients will be hospitalized in the surgery Department, and many of them - surgical treatment.

Emphysema tissue (gr. emphysema - bloating) - a collection of free bubbles of air or other gases in the tissues, where these do not occur.
Air bubbles in adipose tissue autopsy determined the naked eye; when feeling they cause the crepitation. Tissue emphysema should be differentiated from the rotten inflammation, accompanied by the formation of putrefactive gases, such as anaerobic gangrene, as well as from the post-mortem signs cadaveric decomposition (the so-called corpse emphysema, which is characterized by the accumulation of gas not only in adipose tissue, but also in the liver, spleen, in the lumen of the vessels).
Localization distinguish subcutaneous emphysema and mediastinum.
Mediastinal emphysema occurs when a wound of the chest cavity, when interstitial or bullous emphysema (see) at the time of the attack severe coughing due to the gap podplavlennaja bubbles and distribution of air at the root of the lung tissue, and from there into the mediastinum. The air may spread to the tissue of the neck, which is especially clearly determined by the swelling subclavian areas, and then, in the subcutaneous tissue of the upper section of the chest. Air injection with each breath leads to a sharp increase of pressure in the tissues, compression of the large veins, and the trachea and death from cardiovascular disease or asphyxia.
Gas accumulation in the soft tissue of the whole body occurs in conditions of great exhaustion of the atmosphere (at the altitude of more than 19 000 m above ur. m) by reducing total barometric pressure. It is based on the so-called high-rise boiling tissue fluids and gas production through the allocation of fluids and tissues of the body dissolved in them nitrogen, carbon dioxide and oxygen. Stay more than a few seconds in such conditions deadly.


Subcutaneous emphysema - accumulation of gas bubbles in the subcutaneous tissue, and sometimes also in the deeper tissues.
Subcutaneous emphysema may occur as a result of penetration of atmospheric gases, and gases formed in the tissues (see Anaerobic infection; Wounds, wounds). In this latter case, subcutaneous (generally tissue) emphysema is an important and terrible sign, indicating the development of gas gangrene or gas phlegmon.
The penetration of atmospheric gases into the thickness of the tissue frequently occurs from within, from respiratory or pneumatic cavities (sinuses) when they are damaged. Such, for example, emphysema chest wall with a closed fracture of the ribs, with the introduction of its fragment in the lung parenchyma. Much less often the source of emphysema is the digestive tract, mainly the esophagus when it perforation. Perhaps the development of subcutaneous emphysema when rupture of the stomach caused by the pyloric stenosis. The entry of air through the wound coverings in open injuries is possible in cases when the wound has a suction effect is especially when the outer pneumothorax (see Pneumothorax, traumatic), rarely with penetrating wound of large joints (especially in the knee). The air nasosny through the wound with breath (in the pleural cavity), bending (in the cavity of the knee joint) replaced back with expiration extension; partly it out through the wound channel out; partly comes into the surrounding tissue, mainly in the loose tissue. When the outer valve pneumothorax all displaced from the pleural cavity, the air is blown into the tissues and emphysema can be a very large, far be extended to all the trunk, neck, and head out on a limb.
Small subcutaneous emphysema sometimes occurs in the area of needle holes after insufflation of gas in the cavity and tissues of the body for therapeutic or diagnostic purposes - for example, the imposition of artificial pneumothorax, pneumoperitoneum, if astropavlograd etc. Naoshima emphysema tissues can be observed around gunshot wounds shot; it is called the powder gases.
Signs of subcutaneous emphysema are: diffuse swelling without inflammatory skin changes, similar in appearance to swelling; find palpation gas crepitus, which compared to the crunch compressed snow; tympanic at percussion. To identify the earliest degrees emphysema associated with gas production in tissues in anaerobic infections, there are a number of special techniques (see the Wounds, wounds). The most convincing results are obtained in these cases, x-ray examination.
Subcutaneous emphysema, even at considerable size, not dangerous and is mostly diagnostic value, indicating damage to an organ or cavity. She disappears spontaneously, as resorption of gas from the tissue that is usually within a few days and does not require any remedial measures. However, we must be quite sure that appears when you open the damage emphysema is not associated with interstitial gas generation, i.e., anaerobic infection.
The danger occurs when rapidly increasing emphysema chest wall; and spread to the neck, first under the skin, then in deep tissues of the neck, and hence fibre in the mediastinum, it can cause compression of the bodies of the last and development terrible picture mediastinal syndrome (see Mediastinum). In these cases, you need urgent intervention to stop the discharge of air in tissues (for example, to eliminate the valve mechanism with pneumothorax) interrupting the spread his "barrier" cuts the skin and subcutaneous tissue that hold the top edge of the collarbones and jugular depression.