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An Unusual Cause for Noninfectious Subcutaneous Emphysema of the Upper ExtremityA Case Report
Aakash Chauhan, MD, MBA1; Colin Brabender, MD1; Ronald J. Mistovich, MD1; Patrick J. Demeo, MD1; Bradley A. Palmer, MD1
1 Department of Orthopaedics, Allegheny General Hospital, 1307 Federal Street, 2nd Floor, Pittsburgh, PA 15212. E-mail address for B.A. Palmer: bpalmer1@wpahs.org
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Investigation performed at the Department of Orthopaedics, Allegheny General Hospital, Pittsburgh, Pennsylvania



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Case Connector, 2013 Dec 24;3(4):e135 1-4. doi: 10.2106/JBJS.CC.M.00161
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Extract

Subcutaneous emphysema after trauma should raise immediate suspicion for a necrotizing soft-tissue infection. However, there are certain circumstances in which subcutaneous emphysema is the result of a benign or noninfectious process. In the literature, subcutaneous emphysema has been reported secondary to high-pressure injection injuries, factitious self-injection of air and chemical substances in the extremities, elbow arthroscopy, air-sucking phenomenon from traumatic lacerations, and iatrogenic use of hydrogen peroxide in the face and extremities1-13. Surgical evaluation should be obtained for the assessment of subcutaneous emphysema so that, if necessary, immediate surgical intervention can be performed. We report a case of noninfectious subcutaneous emphysema of the upper extremity with an unusual cause.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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