Palpable Crepitus in a Patient with Subcutaneous Emphysema andCrepitus and Subcutaneous Emphysema

An 86-year-old woman with a history of severe emphysema presented to the emergency department with sudden-onset shortness of breath. Two weeks earlier, she had been treated for community-acquired pneumonia that was complicated by a pneumothorax on the right side, leading to the temporary insertion of a chest tube. The drain was removed before the patient was discharged, without complication. On examination during the current presentation, 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 tomography of the chest included emphysematous changes in the lungs, a moderate pneumothorax on the right side, and extensive subcutaneous emphysema. A chest tube was reinserted; however, the patient’s clinical status continued to deteriorate, and ultimately a decision was made to pursue comfort care.

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