Clinical Image:
A 73-year-old man with moderate pulmonary emphysematous changes
developed left-sided pneumothorax and dyspnea. Marked subcutaneous
emphysema was observed on the neck and left anterior chest, along with
facial disfiguration (Figure 1). Computed tomography revealed
retropharyngeal, mediastinal, and subcutaneous emphysema. The emphysema
involved the left anterior chest, bilateral neck regions, the
surrounding temporal muscles, and the posterior region. Furthermore,
pneumomediastinum, extending to the laryngopharynx, and air in the
retropharyngeal space were radiographically observed (Figure 2). Based
on these results, the patient was diagnosed with retropharyngeal
emphysema. Fortunately, he did not show symptoms of airway obstruction.
A chest drain was placed for treatment, and drainage was continued.
Following drainage, the pneumothorax improved, and the retropharyngeal,
mediastinal, and subcutaneous emphysema resolved completely.
Retropharyngeal emphysema can result from severe maxillofacial injuries
or traumatic injury to the pharynx or esophagus, or it can occur
spontaneously. Moreover, it can also be caused by iatrogenic factors
such as dental procedures or tonsillectomy.1
Surgical incision and drainage are often indicated for mediastinitis or
symptoms of airway obstruction.1 Complications of
mediastinitis are associated with poor prognosis.2 The
appearance of worsening dyspnea, chest pain, abdominal pain, or signs
and symptoms related to shock should be carefully
monitored.2