Micro-drainage for management of extensive subcutaneous emphysema: A case report

Extensive subcutaneous emphysema (ESE) is a rare complication requiring prompt intervention to prevent serious outcomes. We present the case of a man in his sixties with chronic obstructive pulmonary disease and a history of pulmonary tuberculosis, admitted with community-acquired pneumonia and respiratory failure. Following central venous line placement, he developed progressive ESE refractory to standard chest tube drainage. A novel approach using a fenestrated microcatheter was employed to manage the ESE. The catheter, connected to an underwater seal and combined with targeted compressive massage, successfully evacuated approximately 2500 mL of air, leading to complete resolution within 24 hours. This case highlights the efficacy of minimally invasive drainage techniques in managing refractory ESE, offering a safe and effective alternative to surgical interventions. • Micro-drainage technique effectively manages extensive subcutaneous emphysema. • Sequential compressive massage enhances hydrostatic pressure, promoting drainage. • Fenestrated catheter with underwater seal offers a minimally invasive approach. • Procedure results in rapid resolution of emphysema without recurrence. • This method may be considered for routine management of extensive subcutaneous emphysema.