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Vol. 16. Issue 2.
Pages 321-329 (March - April 2010)
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Vol. 16. Issue 2.
Pages 321-329 (March - April 2010)
Caso Clínico
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Enfisema subcutâneo maciço – Tratamento com drenos subcutâneos
Massive subcutaneous emphysema – Management using subcutaneous drains
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4086
Maria Sucena1,
Corresponding author
maria.sucena@hotmail.com

Alameda Prof. Hernâni Monteiro 4200 – Porto.
, Fernando Coelho2, Teresa Almeida3, António Gouveia4, Venceslau Dr. Hespanhol5,6
1 Assistente Hospitalar de Pneumologia
2 Interno do Internato Complementar de Pneumologia
3 Assistente Hospitalar de Cirurgia Geral, Serviço de Pneumologia do Hospital de S. João EPE, Porto. Dr. Amadeu Pimenta
4 Assistente Hospitalar Graduado de Cirurgia Geral, Serviço de Pneumologia do Hospital de S. João EPE, Porto Dr. Amadeu Pimenta
5 Chefe de Serviço de Pneumologia, Director do Serviço de Pneumologia
6 Serviço de Pneumologia do Hospital de S. João EPE, Porto Director: Prof
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Resumo

O enfisema subcutâneo é uma complicação relativamente comum na sequência de técnicas invasivas, procedimentos cirúrgicos e algumas patologias médicas. Na maior parte dos casos apenas causa sintomatologia minor e o tratamento é habitualmente conservador. Mesmo quando grave, raramente tem consequências patofisiológicas significativas, apesar de ser extremamente desconfortável para o doente.

Os autores descrevem um caso clínico de enfisema subcutâneo maciço, de rápida instalação, após saída acidental de tubo de drenagem torácica, em doente com pneumotórax espontâneo secundário e fístula broncopleural. O enfisema foi tratado através da colocação, sob anestesia local, de dois drenos subcutâneos na parede anterossuperior do tórax, conectados a sacos de drenagem. Após a colocação dos drenos subcutâneos verificou-se uma franca melhoria clínica do doente, com descompressão eficaz do enfisema subcutâneo. No presente caso clínico, a técnica de drenagem do enfisema maciço mostrou-se simples, segura e eficaz, permitindo o alívio sintomático imediato.

Palavras-chave:
Enfisema subcutâneo
dreno subcutâneo
tratamento
Abstract

Massive subcutaneous emphysema is a relatively common complication in invasive techniques, surgical practice and some medical conditions. Subcutaneous emphysema is usually treated conservatively and may only cause minimal symptoms. Even when it is severe, subcutaneous emphysema rarely has pathophysiologic consequences, but it is extremely uncomfortable for the patient.

The authors report a case of massive and rapid developing subcutaneous emphysema following chest tube displacement in a patient with spontaneous se- condary pneumothorax and large air leak. The emphysema was treated with two subcutaneous drains, inserted using local anesthesia, on both sides of the chest (antero-superior thoracic wall), connected to drainage bags. The drains produced a dramatic clinical improvement and provided effective decompression of the subcutaneous emphysema.

In this clinical case, the technique of drainage of severe subcutaneous emphysema using subcutaneous drains was safe, easy and effective, affording immediate symptom relief.

Key-words:
Subcutaneous emphysema
subcutaneous drain
management
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