Extensive Subcutaneous Emphysema Following Thoracoscopic Lung Wedge Resection

Subcutaneous emphysema (SCE) is a recognized but uncommon complication of thoracic surgery. While it is often self-limiting, severe cases may progress rapidly and compromise the airway. We report the case of a 71-year-old man with interstitial lung disease who developed extensive SCE two weeks after thoracoscopic wedge resection of the lung. He presented with progressive facial and neck swelling, hoarseness, and dyspnea. On examination, he was tachypneic with extensive subcutaneous crepitus. Imaging confirmed widespread emphysema extending through the thoracic wall and soft tissues with associated pneumomediastinum. Bilateral "blowhole" incisions were performed with wet dressings and manual decompression; however, his condition deteriorated, and he developed stridor, requiring emergency intubation in the operating room. Heliox was considered but unavailable. Definitive improvement was achieved after placement of a 24 Fr subcutaneous drain connected to continuous suction. The patient was gradually weaned from ventilatory support and discharged in stable condition. This case underscores the importance of early recognition, escalation of therapy when conservative measures fail, and the potential role of subcutaneous drainage in severe postoperative SCE.