Presentation
Presents with lethargy and swelling under the skin. The owners were out for the day, and there is no known trauma. Another dog is present in the household.
Patient Data
There is marked subcutaneous emphysema and gas within the cervical tissues to the level of the thoracic inlet.
There is severe generalized subcutaneous emphysema surrounding the thorax. The 5th, 6th and 7th left ribs are fractured with moderate displacement. The fascial plane overlying this region appears disrupted. There is an increased opacity throughout the pulmonary parenchyma, worse within the left hemithorax. There is a slight leftward mediastinal shift.
Left-sided thoracic wall trauma with pulmonary contusions and severe subcutaneous emphysema. Mediastinal shift suggestive of partial left-sided lung lobe collapse.
Case Discussion
Surgical resection of the left cranial lung lobe was performed. The surgeons filled the thorax with saline and observed bubbles coming from the junction of the left cranial lung lobe with the hilus. On the left caudal lung lobe, two bullae were present that contacted the pleural surface, and this area was surrounded by hemorrhage and collapse of the lung. There was a rupture of the intercostal muscles in the 6th intercostal space.
There are two possibilities for the path of the subcutaneous emphysema. Either the trauma to the left thoracic wall allowed air to escape, or the rupture seen at surgery near the hilus of the lung was close enough to the cervical mediastinum to allow air to travel cranially and then disperse into the subcutaneous tissues. The minimal mediastinal shift and lack of visible pneumothorax supports the air traveling through the cervical mediastinum. A direct communication between the thoracic trauma and subcutaneous tissue usually leads to a localized collection of air.
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