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Extensive subcutaneous emphysema from scalp to lower limbs in a 44-year old
  1. Balamrit Singh Sokhal1,
  2. Sowmya Prasanna Kumar Menon1,
  3. Harrypal Panesar2 and
  4. Sriram Rajagopalan1,2
  1. 1Medical School, Keele University, Keele, Staffordshire, UK
  2. 2Royal Stoke University Hospital, Stoke-on-Trent, Stoke-on-Trent, UK
  1. Correspondence to Balamrit Singh Sokhal; w9b69{at}


A 44-year-old man was admitted after being found suspended by his ankles from a bridge for 5 days. The events leading to it was not clearly known initially. On examination, the patient was hypotensive and hypothermic, airway was oedematous and both lower limbs were mottled with dusky feet. Both foot pulses were impalpable, with prolonged capillary refill time and sensation barely present. Doppler signals were not heard in the feet, but groin pulses and popliteal signals were present. On CT, the patient had bilateral pneumothoraxes, extensive subcutaneous emphysema throughout the body from the subcutaneous tissue of the scalp to both lower limbs and pneumomediastinum and pneumoperitoneum. CT angiogram showed opacification up to proximal crural vessels and absence beyond. After multispeciality input and optimisation of his physiology, he underwent bilateral below knee amputations as they were non-salvageable.

  • trauma
  • vascular surgery

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  • Contributors BSS and SR were involved in the care of the patient. BSS, SPKM, HP and SR were involved in writing the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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