Assarian A, Zaidi A Z.
Spontaneous subcutaneous emphysema.
Professional Med J Jan ;12(1):111-3.

A 23 year-old (tall and thin) male was admitted in the hospital with three days history of acute neck pain, dysphagia and odynophagia. Dysphagia was mainly to solid foods and he was not complaining of any respiratory symptoms. The above symptoms started without any trauma or precipitating factors and he was in his usual state of good health prior to this event. He had no current history of trauma, aspiration of foreign body or drug abuse. Apart from smoking there was no any history of medical or surgical disease of note. On examination he was well, temperature was 36.5 C, The blood pressure was 100/60 mm Hg and the pulse was 80 beats/min. There was symmetrical swelling around the neck with crepitation on palpation. There was no chest wall swelling or crepitation on examination. The chest evaluation demonstrated symmetrical and bilateral clear breath sounds plus normal heart sounds without murmur. An arterial blood gas analysis in room-air showed: pH 7.413, Pa02 13.59 kpa, paC02 5.40 kpa, Sa02 97.9% and HC03 24.8 mmol/l. the hemoglobin was 15.6 g/dI, The hematocrit was 43%, the white cell count was 6800 and the platelet as 190,000 per cubic mm. The blood chemistry and urinalysis were normal. The chest and neck radiograph showed pnoumomediastinum and subcutaneous emphysema in the neck but there was no any evidence of leakage from oesophagus. He was put on free fluids and subsequently light diet, analgesia and close observation. After three days his clinical symptoms alleviated to a great extent. He was discharge well from hospital after four days.

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