Palpable Skin Crepitus on Physical Exam Notice these air bubbles under the skin. An 86-year-old woman with a history of severe emphysema presented to the emergency department with sudden-onset shortness of breath. She had recently been treated for pneumonia that was complicated by pneumothorax on the right side, leading to the temporary insertion of a chest tube. At the current presentation, extensive palpable crepitus could be clearly visualized in the neck (shown in video). Subcutaneous emphysema, strictly speaking, refers to gas in the subcutaneous tissues. But the term is generally used to describe any soft tissue emphysema of the body wall or limbs since the gas often dissects into the deeper soft tissues and musculature along fascial planes. Air extravasation in other body cavities and spaces can cause pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and pneumothorax. The air travels from these areas along pressure gradients between intra-alveolar and perivascular interstitium, spreading to the head, neck, chest, and abdomen by connecting fascial and anatomic planes. Air will preferentially accumulate in subcutaneous areas with the least amount of tension until the pressure increases enough to dissect along other planes, causing extensive subcutaneous spread which can result in respiratory and cardiovascular collapse. On physical examination, the most common finding associated with subcutaneous emphysema is crepitus on palpation (the sensation of air under the skin as long with crackling or popping sounds). #skin #Palpable #Crepitus #Subcutaneous #Emphysema #PhysicalExam #Clinical #Video
