Management of extensive subcutaneous emphysema and pneumomediastinum by micro-drainage: time for a re-think?

Extensive subcutaneous emphysema (ESE) is not only disfiguring, uncomfortable and alarming for the patient, but can rarely be associated with airway compromise, respiratory failure and death. Traditionally considered a cosmetic nuisance, few reports on interventions to relieve ESE exist. Most interventions are too invasive and have not been widely used. Fenestrated catheters have been reported to be effective in ESE. We report our experience on microdrainage with a fenestrated catheter and compressive massage in a 50-year-old man with ESE following pigtail insertion for drainage of lung abscess. The apparatus is easily constructed and the procedure is simple, painless, minimally invasive, highly ef fective and cosmetically aesthetic. Placement of an underwater trap and visualisation of bubbling can be used as end-points for adequate compressive massage. Routine management with this catheter can be considered as the procedure of choice for ESE.