Dylan V. Stevens, Ann Q. Tran, Eleanore Kim
A 74-year-old man presented with a 10-day history of fever, cough, and progressive dyspnea. The patient was diagnosed with severe pneumonia related to COVID-19, after a positive polymerase chain reaction test and radiographic imaging (Fig A). The hospital course was complicated by respiratory failure requiring orotracheal intubation. Refractory hypoxia prompted increased levels of positive end-expiratory pressure (up to 18 cm H2O) and prone positioning. Upon supination, subcutaneous emphysema extended from the chest to the face, unilaterally in the conjunctiva (Fig B), and bilaterally around the eyelids (Fig C). Complete ophthalmologic examination did not reveal any evidence of orbital compartment syndrome or vascular occlusion. (Magnified version of Fig A–C is available online at www.aaojournal.org).
Rai, Ravneet S.; Rowlands, Megan A.; Kally, Peter M.; Warren, Floyd
The authors describe the case of a 19-year-old female who suffered posttraumatic emphysema of the optic nerve sheath. She suffered massive head trauma requiring emergent neurosurgery and was incidentally found to have air in her optic nerve sheath on CT scan. At 6 weeks follow up, her visual acuity (20/25 uncorrected) and color perception in the affected eye were excellent. Her examination was notable for an afferent pupillary defect, mild disc pallor, and optic nerve atrophy on optical coherence tomography. This is a case of a patient with posttraumatic optic nerve sheath emphysema who recovered excellent visual function and received follow-up ophthalmic imaging.
Bagheri, Abbas; Veisi, Amirreza; Memarzade, Sayed Ezatollah; Tavakoli, Mehdi
A 5-year-old boy was accidentally injured by a compressed air blast to his right eye and developed periorbital and subconjunctival emphysema and proptosis subsequently. CT scan showed periorbital subcutaneous and intraorbital emphysema around the right eye, as well as intracranial and cervical emphysema without frank fractures in orbital bones. He was examined under sedation, and the subconjunctival air was aspirated. He was also prophylactically treated with topical and systemic antibiotics to prevent infection. Emphysema was resorbed entirely within 3 weeks. In conclusion, compressed air injury can occur in a child and manifest with orbital and periorbital emphysema without any detectable fracture and any clear entrance site and may need emergent management to save the vision or upper respiratory airways.
Ziya Akingol, Safak Karslioglu, Didem Serin
Cervicofacial emphysema (CFE), mostly seen after trauma or dental procedures, is an unexpected, extremely rare condition after uncomplicated dacryocystorhinostomy (DCR). It may be misdiagnosed as angioedema or necrotizing fasciitis. In this article, we present the case of a 40-year-old female with CFE twice after uncomplicated unilateral DCR for left and right sides on different operative days. CFE was confirmed by computed tomography, demonstrating extensive air within subcutaneous tissues of the face, neck, and orbital cavity. Subcutaneous crepitation supported the diagnosis. This is the first case report, to the best of our knowledge, describing a patient with recurrent massive CFE after each unilateral DCR.