Management of post lobectomy subcutaneous emphysema; a case report with literature review

INTRODUCTION: Subcutaneous emphysema is an extremely rare complication after lobectomy. The current study aims to report a case of lung cancer developing extensive subcutaneous emphysema after lobectomy. CASE PRESENTATION: A 73-year-old man presented with dyspnea and cough for one month duration associated with wheeze and sputum. He was a chronic heavy smoker (100 pack/year). Work up revealed squamous cell carcinoma. Although he had poor pulmonary function tests, he underwent left upper lobectomy. On the fifth postoperative day, he was discharged from the hospital as there was no air leak and the lung remained expanded 15 hours after clamping of the thoracostomy tube. Two days later, the patient developed generalized subcutaneous emphysema. The patient was re-admitted to the hospital and a thoracostomy tube was inserted. The lung expanded upon insertion while the subcutaneous emphysema remained the same and even slightly increased over night. A 3 cm incision was made at the left infra-clavicular area and a negative pressure applied to it. The subcutaneous emphysema completely subsided a few hours after this intervention. DISCUSSION: Because of the benign course, the majority of cases of subcutaneous emphysema (mild to moderate) only need nonoperative management alongside treatment of the predisposing factors. These patients may need nothing other than bed rest, good analgesia, supplemental oxygen, and reassurance. CONCLUSION: Subcutaneous emphysema after lobectomy prolongs hospital stay. It mainly occurs in cases with poor pulmonary function tests, steroid use, and those with extensive adhesion.