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We have also experienced an unusual presentation of surgical emphysema. In our case, a 28 year old triathelete attended the Accident and Emergency Department one day after competing in a Triathlon. During the cycling stage of the event he sustained an injury to the posterior aspect of his thigh from the pedal of his bicycle. He did not consider the injury to be significant and so completed the remaining running section of the Triathlon.
The following day he noticed that the thigh involved was swollen and had developed a ‘crackly’ feeling. On examination he was well, apyrexial, and had a 1 cm full thickness wound situated 6 cm superior to the popliteal fossa of his left thigh. There was no surrounding erythema, and although there was no tenderness on palpation there was extensive crepitus over both the anterior and posterior aspects of the left thigh. Blood tests showed a normal white cell count and c-reactive protein. A radiograph showed extensive gas within the soft tissues of the thigh (Figure 1, Figure 2) . The patient was admitted for overnight observation, and was discharged the next day following a dramatic decrease in the extent of the surgical emphysema.
Figure 1AP radiograph of the left knee showing gas within the soft-tissues.
The obvious differential diagnosis in this case was infection of the soft tissues of the thigh by a gas-forming organism. However, as the patient remained apyrexial and systemically well whilst in hospital, had normal blood results and the wound was non-tender, non-erythematous, and had no discharge, we felt that it was safe to exclude this as a diagnosis. In essence the wound had acted as a one way valve during the running stage of the competition, trapping air within the soft tissues.
Yours faithfully,
References
Russell P.G.
Smith M.
Subcutaneous emphysema following the use of a high- pressure water jet.
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