Surgical Emphysema

Surgical Emphysema or Subcutaneous Emphysema-

 means presence of air in the subcutaneous plane.

Right Sided Multiple Rib Fractures with Subcutaneous Emphysema

Characteristic clinical finding is crackling feel or creps.

 

The blown out appearance is sometimes described as 

Michelin Man (Tyre Man) appearance.

Causes

1. Multiple Rib Fractures- Pleural Tear

2. Penetrating Chest Injury  (Stab /Gunshot)

3. Rupture of  Emphysamatic Bullae on to the mediastinum.

4. Rupture Esophagus

5. Tracheal Injury

6. Facial Bone Fractures ( as sinuses contain air )

7. Infection with Gas forming organisms

Other Conditions producing Creps on palpation

1. Face, Neck, Chest - Surgical Emphysema

2. Bone – Definitive Sign of  fracture

3. Joint- Osteo Arthritis

4. Tendon – Teno Synovitis,inflammation of tendon sheath.

Carcinoma Colon- Synchronous Lesions

Carcinoma Colon- Synchronous Lesions

Definition : Occurrence of two or  more primary tumors identified in the same patient and at the same time.

   The most voluminous synchronous cancer is called "index" cancer.

   Synchronous Lesions are caused by 
                                  common genetic and environmental factors.

   Overall incidence of synchronous colorectal cancers 
                                   varies between 2% to 10%.

   Hence a complete colonoscopic work up is indicated in every case.