DOI: 10.36347/sjmcr.2017.v05i03.018

Pages: 190-191

A sixty-nine-year-old male fell down and his right chest bumped into something while he was drunk. On arrival, he showed swelling of the face, neck, abdomen, scrotum and extremities. An emergency chest roentgen revealed massive subcutaneous emphysema. Subsequently, CT demonstrated right rib fracture, a medium amount of right pneumothorax and a small amount of hemothorax and pneumomediastinum, in addition to massive subcutaneous emphysema throughout the whole body. After CT, stridor was detected at the neck by auscultationwith a stereoscopic sound field. Tracheal intubationwas performed because he had signs of upper airway obstruction. He was diagnosed with trauma-induced thoracic injury with massive subcutaneous emphysema, laryngeal edema. He was extubated on the 7th day of hospitalization, after the improvement of pneumothorax and subcutaneous emphysema. He discharged on foot on the 16th day of hospitalization. This case is unique because he had a discrepancy in the volume of gas between the intrathoracic cavity and the subcutaneous region. This might have been due to local intrathoracic adhesion at the site of lung injury that had been caused by his rib fracture. A deep-seated mass in the neck may block the venous return of the epiglottis, leading to life-threatening laryngeal edema and upper airway obstruction. Accordingly, physicians should pay attention to this complication, even in cases in which thoracic injury is induced by a low energy accident.