Crepitation, subcutaneous [Subcutaneous crepitus, subcutaneous emphysema]
Crepitation, subcutaneous [Subcutaneous crepitus, subcutaneous emphysema]: Excerpt from Professional Guide to Signs & Symptoms (Fifth Edition)
When bubbles of air or other gases (such as carbon dioxide) are trapped in subcutaneous tissue, palpation or stroking of the skin produces a crackling sound called subcutaneous crepitation or subcutaneous emphysema. The bubbles feel like small, unstable nodules and aren’t painful, even though subcutaneous crepitation is commonly associated with painful disorders. Usually, the affected tissue is visibly edematous; this can lead to life-threatening airway occlusion if the edema affects the neck or upper chest.
The air or gas bubbles enter the tissues through open wounds from the action of anaerobic microorganisms or from traumatic or spontaneous rupture or perforation of pulmonary or GI organs.
History and physical examination
Because subcutaneous crepitation can indicate a life-threatening disorder, you’ll need to perform a rapid initial evaluation and intervene if necessary. (See Managing subcutaneous crepitation.)
When the patient’s condition permits, palpate the affected skin to evaluate the location and extent of subcutaneous crepitation and to obtain baseline information. Repalpate frequently to determine if the crepitation is increasing. Ask the patient if he’s experiencing any pain or having difficulty breathing. If he’s in pain, find out where the pain is located, how severe it is, and when it began. Ask about recent thoracic surgery, diagnostic tests, and respiratory therapy or a history of trauma or chronic pulmonary disease.
Medical causes
Gas gangrene
Subcutaneous crepitation is the hallmark of this rare, but commonly fatal, infection that’s caused by anaerobic microorganisms. It’s accompanied by local pain, swelling, and discoloration as well as bullae and necrosis. The skin over the wound may rupture, revealing dark red or black necrotic muscle and a foul-smelling, watery or frothy discharge. Related findings include tachycardia, tachypnea, a moderate fever, cyanosis, and lassitude.
Orbital fracture
This fracture allows air from the nasal sinuses to escape into subcutaneous tissue, causing subcutaneous crepitation of the eyelid and orbit. The most common sign of an orbital fracture is periorbital ecchymosis. Visual acuity is usually normal, although a swollen eyelid may prevent accurate testing. The patient has facial edema, diplopia, a hyphema and, occasionally, a dilated or unreactive pupil on the affected side. Extraocular movements may also be affected.
Pneumothorax
Severe pneumothorax produces subcutaneous crepitation in the upper chest and neck. In many cases, the patient has chest pain that’s unilateral, rarely localized initially, and increased on inspiration. Dyspnea, anxiety, restlessness, tachypnea, cyanosis, tachycardia, accessory muscle use, asymmetrical chest expansion, and a nonproductive cough can also occur. On the affected side, breath sounds are absent or decreased, hyperresonance or tympany may be heard, and decreased vocal fremitus may be present.
Rupture of the esophagus
A ruptured esophagus usually produces subcutaneous crepitation in the neck, chest wall, or supraclavicular fossa, although this sign doesn’t always occur. In a rupture of the cervical esophagus, the patient has excruciating pain in the neck or supraclavicular area, his neck is resistant to passive motion, and he has local tenderness, soft-tissue swelling, dysphagia, odynophagia, and orthostatic vertigo.
Life-threatening rupture of the intrathoracic esophagus can produce mediastinal emphysema confirmed by a positive Hamman’s sign. The patient has severe retrosternal, epigastric, neck, or scapular pain and edema of the chest wall and neck. He may also display dyspnea, tachypnea, asymmetrical chest expansion, nasal flaring, cyanosis, diaphoresis, tachycardia, hypotension, dysphagia, and fever.
Rupture of the trachea or major bronchus
This life-threatening injury produces abrupt subcutaneous crepitation of the neck and anterior chest wall. The patient has severe dyspnea with nasal flaring, tachycardia, accessory muscle use, hypotension, cyanosis, extreme anxiety and, possibly, hemoptysis and mediastinal emphysema confirmed by a positive Hamman’s sign.
Other causes
Diagnostic Tests
. Endoscopic tests, such as bronchoscopy and upper GI tract endoscopy, can cause rupture or perforation of respiratory or GI organs, producing subcutaneous crepitation.
Respiratory treatments
Mechanical ventilation and intermittent positive-pressure breathing can rupture alveoli, producing subcutaneous crepitation.
Thoracic surgery
Subcutaneous crepitation can occur if air escapes into the tissue in the area of the incision.
Special considerations
Monitor the patient’s vital signs, especially respirations, frequently. Because excessive edema from subcutaneous crepitation in the neck and upper chest can cause airway obstruction, be alert for signs of respiratory distress such as dyspnea. Tell the patient that the affected tissues will eventually absorb the air or gas bubbles, decreasing the subcutaneous crepitation.
Pediatric pointers
Children may develop subcutaneous crepitation in the neck from ingestion of corrosive substances that perforate the esophagus.
Patient counseling
Warn patients with asthma or chronic bronchitis to be alert for subcutaneous crepitation, which can signal pneumothorax, a dangerous complication.
Pictures
![Crepitation, subcutaneous [Subcutaneous crepitus, subcutaneous emphysema] - 2540.png](/bookimages/8/2540.png)
Book Source Details
- Book Title: Professional Guide to Signs & Symptoms (Fifth Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2006 Lippincott Williams & Wilkins.
More About Emphysema
More Medical Textbooks Online about Emphysema
Review other book chapters online related to Emphysema:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: Crepitation, subcutaneous [Subcutaneous crepitus, subcutaneous emphysema] (Nursing: Interpreting Signs and Symptoms)
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
