J Korean Orthop Assoc.  2013 Dec;48(6):475-479. 10.4055/jkoa.2013.48.6.475.

Subcutaneous Emphysema of Lower Extremity after Knee Arthroscopy

• Park KJ
• Choi ES
• Kim YM
• Kim DS
• Shon HC
• Cho BK
• Park JK
• Choi SM
• Eun HJ

• KMID: 2185283
• DOI: http://doi.org/10.4055/jkoa.2013.48.6.475

Abstract

Subcutaneous emphysema of lower extremity is a rare disease entity. Crepitation and swelling on physical examination and gas on radiographs raise the concern of infection due to the presence of gas gangrene forming organisms. Therefore, delay of diagnosis and appropriate management can be a major predisposing factor for sepsis and further associated high mortality. We experienced a rare case of subcutaneous emphysema of the right lower extremity after knee arthroscopy; life-threatening infection was ruled out by physical examination and laboratory testing. The patient recovered uneventfully with conservative management. Therefore, we report on this case with a review of current literature.

Keyword

subcutaneous emphysema; knee; arthroscopy; gas ganrene; differential diagnosis

MeSH Terms

Arthroscopy*
Causality
Diagnosis
Diagnosis, Differential
Gas Gangrene
Humans
Knee*
Lower Extremity*
Mortality
Physical Examination
Rare Diseases
Sepsis
Subcutaneous Emphysema*

Figure

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  Figure 1 Sonograph shows an anechoic lesion (large arrow) with a peripheral echogenic wall on the prepatellar area and two small cysts (small arrows).

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  Figure 2 There is a relationship between the knee joint and the cyst. Therefore, by injection of saline into the knee joint, the cysts are filled with saline.

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  Figure 3 Anteroposterior radiographic view of the knee and thigh showing extensive subcutaneous emphysema.

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  Figure 4 Axial contrast-enhanced computed tomography scan shows a large amount of air within muscle bellies and interfascial planes in thigh and knee. However, there were no fluid collections or abscess pockets.

Reference

1. Deshmukh NV, Shah MM. Extensive subcutaneous emphysema following arthroscopy: a case report. Knee Surg Sports Traumatol Arthrosc. 2002; 10:119–121.

2. Dexel J, Schneiders W, Kasten P. Subcutaneous emphysema of the upper extremity after elbow arthroscopy. Arthroscopy. 2011; 27:1014–1017.

3. Robbins PL, Sutherland DE, Najarian JS, Bernstein WC. Emphysema of the leg as a presenting sign of large-intestinal perforation: report of two cases. Dis Colon Rectum. 1977; 20:144–148.

4. Henderson CE, Hopson CN. Pneumoscrotum as a complication of arthroscopy. A case report. J Bone Joint Surg Am. 1982; 64:1238–1240.

5. Sleigh JW, Linter SP. Hazards of hydrogen peroxide. Br Med J (Clin Res Ed). 1985; 291:1706.

6. Fernyhough J, Razza BE. Tension pneumarthrosis complicating arthroscopy of the knee. Am J Sports Med. 1992; 20:479–480.

7. Hamilton S, Towers MJ, Pegum JM. Pneumomediastinum due to a sucking wound of the knee. AJR Am J Roentgenol. 1989; 152:1131–1132.

8. Lotman DB. Pneumoperitoneum and acidosis during arthroscopy with CO2. Arthroscopy. 1987; 3:185–186.