Massive traumatic subcutaneous emphysema - Case :
A 90 yr old fell on the rim of his bed at 0900h. At 18.00 h he developed severe subcutaneous emphesema : within 45 minutes his face, his thoracic wall, his arms and his abdomen were twice their normal size. In Europe this characteristic face with the swollen eyes is called the 'Michelin man' : the Michelin tyre company used a comic swollen figure as an advertisement. The following ct scan revealed a displaced rib fracture on the right. On the normal thoracic Xray there was no sign of a pneumothorax. I asked the ER nurse to put a finger on the skin untill she feels more solid tissue : Her finger disappears more then 5 cm.