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Sunday, November 20, 2005

Subcutaneous Emphysema in a Canine Patient...

This dog presented with a severe case of subcutaneous emphysema. She has a bloated appearance due to an enormous amount of air that is trapped in the dermal layers of her skin.

Air can enter these layers of tissue in a variety of ways. The most common cause of subcutaneous emphysema is trauma. In the case of this dog the only obvious point of entry was due to some bite wounds she had received in a dog fight about one week prior to her presenting to us. While this condition is usually caused by severe trauma, this dog's wounds were rather mild and were localized in the neck region.

Radiographs were taken to ensure that there wasn't another underlying cause to her condition such as would be found in trauma to the chest, lungs, trachea, etc.

As you look at the radiograph below you can see the white line at the top of the image. That's her skin. That large black space between the skin and her body is air.

While it was a not a life threatening situation this dog did appear to be quite painful at the time.

The next radiograph is of the abdominal region. You can see the outline of the abdominal wall and then the skin is quite far from it. The dog does have quite a bit of mammary development as seen on this radiograph. She had also also whelped a few days before coming in.

This condition is not uncommon and is usually seen in smaller amounts and is known as crepitus; this is the most severe case of subcutaneous emphysema that any of us had ever seen. It was quite interesting.



Blogger Moof said...

T.J. ... that's just awful! *cringe* It looks more than a little uncomfortable.

What do you do for something like that ... ?

November 21, 2005 6:50 AM  
Blogger It's me, T.J. said...

We reduced the air by using 18ga needles. We placed them uniformly down her back and along both sides. She looked like she was undergoing acupuncture.

We then "deflated" her, much like you would an air mattress, by compressing the skin towards the body. The air actually *spewed* out of the needles there was so much of it.

To keep it from recurring you have to seal the point of entry.


November 21, 2005 5:28 PM  
Blogger Moof said...

Gives a whole new meaning to feeling "bloated" ... oooh ouchies!

November 22, 2005 8:16 AM  
Anonymous The Candleman said...

We are so glad to find this information! Our Shar-Pei had a fight and got a puncture wound on his side. The wound healed nicely, but pressing against his side, back and belly sounded like Rice Crispies and felt kind of squishy. We FREAKED OUT!! Anyway, vet said air bubbles and would dissipate in 48 -72 hours. No further problems! THANKS!

March 23, 2007 8:11 AM  
Blogger bev said...

Great stuff! I'm an Australian vet and had a dog come in like this yesterday. He had a 'stake' wound into axillae. I managed to suture muscle layers (multiple) together then SQ then close skin, but the dog is still blown up. Did you have to do any surgical repair to this dog? Did it only require 1 drainage 'session'? If not, how long before return to normal. I have been wondering if perhaps the trachea might need repair? Cheers -speccy cases!

July 29, 2007 6:49 AM  
Blogger It's me, T.J. said...

Hey Bev...

No. We didn't repeat the procedure with this dog and we didn't perform surgery. The owner didn't bring the dog back in for follow-up care either.

It is possible that the trachea may have a "leak" in it. That was our main concern with this dog. Some radiographs with a few oblique views may disclose damage to the trachea, but if you have a lot of air it may be difficult to pinpoint it.

In your case, do you think a bandage for a day or so would help and then re-radiograph the neck?

Interesting case. I would love to see the radiographs!


July 29, 2007 11:31 AM  
Anonymous Anonymous said...

It is very interesting to read what you have written in your comments on SubQ Emphysema.

We have a 6 mo. Pomeranian who has developed this syndrome and the Vet. cannot assertain a positive cause. There has been no trauma to the animal what-so-ever. There is no known other situation, no bites, nothing. The Vet. does believe there may have been possible trachael damage which may have allowed air to enter the SubQ space. We do not know how the animal could have sustained any damage to the trachea.

We are going to refer our Vet. to your site in the hope that addittional information may be available.

If you know of anyone or if anyone reading this, has any further knowledge about this syndrome, please contact us as we need more information regarding this situation.

Thank you,

Gene Blackman
Washington K-9 College

September 18, 2007 8:56 PM  
Blogger It's me, T.J. said...

Hi there Mr. Blackman...

I have made some inquiries and my sources (some of them board certified internal medicine specialists) all state that there had to be some form of trauma to have caused the subcutaneous emphysema in your pup.

A few questions asked by the doctors are:

Has your dog recently been intubated for surgery or other reasons? There could have been some form of injury to the trachea if he has.

Are there any cats or pets in the home? There could have been a puncture wound to the throat that could have caused the symptoms.

If there is not any trauma to the trachea, then there is a possibility that there is has been an injury sustained to the thorax.

I hope that this helps you out.


September 22, 2007 4:54 PM  
Anonymous Gene Blackman said...


We'd like to thank you for your help with our Pomeranian with SubQ. He is now a sprightly, bouncing 8 months old and has only a slight cough to show for the problem he went through. Definite trachea problem. Our vet finally did a wrap on him from the neck to the bottom of the ribcage. This stayed on for 2 weeks. This was done after air tubes were inserted on both his sides to let air disperse. It did.

Again, thanks for your input.

Mr. & Mrs. Gene Blackman
Washington K-9 College

November 15, 2007 5:34 PM  
Blogger It's me, T.J. said...

Hey there Mr. Blackman...

I'm glad you returned and was able to give a good report on your little guy.

A bandage and "Tincture of Time"...

Good job and thanks for the update!

Best Wishes.

November 16, 2007 9:05 PM  
Anonymous Anonymous said...

This is so interesting, our Jack
Russell also started to have problems and his bark started to sound very strange, he started to get air under his skin under neck and and cheeks and even the top of his head. He has not had any trama that we can figure out. Is there any other way for this to happen other than external trauma?
He is on Cephalexin and prednisone.
The air does seem to be disapating some. He was at the vets for 3 days and now home. We are trying to keep him quiet and not bark which is a real feat with a Jack Russell. Thanks Kristi Ott

August 01, 2008 8:40 PM  
Anonymous Nichole B. said...

I just brought my chihuahua to the vet for this. He has air under his skin all over his body, but a large bulge at the neck. We have witnessed to form of trauma....although we do have other dogs that play fairly roughly. However, our vet did xrays and found no source for the punture. He even consulted with a specialist who found nothing. We were told to keep an eye on the dog. If the source had sealed itself off, the air would go away in a week or so. If we saw any change in the dog, discomfort, or he seemed puffier.....we were to bring him in immediately so they could search further with a scope. It has been 3 days.....he doesn't seem to have any more air, but it doesn't seem to be getting any smaller either. Our vet is awesome....but do you have any futher advice for us?

September 21, 2008 5:26 PM  
Blogger It's me, T.J. said...

Hey there Nicole...

It sounds like you guys are doing everything possible and that your veterinarian has a good handle on things.

I don't have any other suggestions right now. Actually, three days really isn't all that long.

Sometimes things just need some "tincture of time".

I wish you and your little guy the best and a full recovery.


September 21, 2008 7:43 PM  
Blogger GiJenn51 said...

I have a greyhound who was in a dogfight about a week ago. She has several puncture wounds. Two were stapled, but they need to come out sue to infection. But her crepidus is not going down at all. She is still pretty bruised. I'm hoping to do the needle therapy to the top of her neck since it looks like she has a balloon.
Thankyou for your recommendations!

November 12, 2008 11:25 AM  
Blogger alexa said...

Thanks for your blogs. My dachshund was attacked by a pitbull yesterday and received a small puncture to his skin (not through the muscle) on his abdomen. I took him to the vet and he checked out OK but was in really terrible shock (it was desperately sad). He is very sore and moving gingerly and he now has crackling, bubbles under the skin which after reading this blog must be the crepitus. Should i be asking for pain meds for him? What type of time line should these bubbles disappear? Can this cause any further damage? He was given steriods for the shock yesterday and is on antibiotics.
Any comments. My poor baby is hurting.

July 15, 2009 10:29 PM  
Anonymous L Crouch said...

I have an 11 week old puppy in the Intensive Care Unit at the Univ of Penn Vet Hospital. She presented with the same symptoms. Essentially she blew up like a big puffer fish. At the U of Penn they have run every test known to mankind....or so it seems. Yesterday, they put a scope down her throat and checked for any abnormalities in her trachea and/or her esophagus...both were normal. Yet the amount of air that she continues to leak into her chest, ect. has not decreased any. The doctors are stumped. They are now talking about keeping her in ICU for another week and if the leaking does not lessen -- go in and do a greater exploratory surgery.

Does anyone have any incite into what the hec is going on? Before this happened the puppy was 100% normal. There is no obvious signs of trauma. We are all pulling are hair out trying to figure out what g=could be going on.

The breed of dog is a Lucas Terrier. Lucas Terriers are very rare. However, the Lucas was originally a cross between a Sealyham Terrier and a Norfolk. Terrier which is better known.

Any help would be so very welcome!

December 24, 2009 3:32 PM  
Anonymous Anonymous said...

Hi Our Lurcher was recently attacked and has a wound on his groin. A day later we noticed when we stroked his back it sounded like rice chrispies under his skin. It freaked us out and the vet diagnosed subq. They have now sealed the wound and put the dog on anti biotic tablets. The vet said the air would disperse gradually. Few days later he still has it but we are hoping it will clear up soon. Your blogs have put our mind at rest.

April 14, 2010 3:41 PM  
Blogger lou said...

We're in Aus. Have a 10yr old lab. Had an op to remove lumps. Drainage pipe allowed air in under the skin. Feels like bubble wrap. Vet said plenty of rest and in time bubbles will disperse. It's been 10 days since the op and yes they air has gone from his legs, underbelly and shoulders. Only a bit of air around his rump. Unfort it take time.

July 24, 2010 4:02 PM  
Anonymous Anonymous said...

Thank you for all your comments...I came home last night and I was patting my dog and found air under her skin...it scared me but she did not seem to be in pain...unfortunately I don't have the finances to take my dog to the vet so thank you for comments and suggest it helps a ...again thanks.

January 13, 2011 11:36 AM  
Anonymous Anonymous said...

My dogs fought last Tuesday & my bulldog suffered a significant amount of injuries, the most severe to the left front paw. He is healing nicely everywhere else but the subcutaneous emphysema is BAD. It extends from his chest into both front paws and on the bad side, all the way to the end of his ribcage. He has lost 4 lbs, 2 since last Thursday. He appears to be healthy (accept the very obvious injuries). He is losing his hair and the skin around the elbow joint is loose and the paw is completely swollen again. The vet is planning to do surgical debridement of the muscle tomorrow morning and further explore the injury. When she first explored it last week, she put penrose drains in which were removed today and sent for culture. There is constant serisanginous fluid draining from the injury and sticky crust forming. Any thoughts/suggestions on what has been done thus far and tomorrow's plan for surgery? Thank you!

July 18, 2011 7:28 PM  
Anonymous Anonymous said...

This article has been really helpful to me. About a week ago, my mom took in my uncle's dog, a fox terrier. Usually, the dog traveled with him where ever he went, but after the dog got into a fight with something, he left it at home. With no food or water available until he got home. Then, about a week afterward, he got arrested.

Anyway. When we picked the dog up at the house, we knew for sure he'd been without food or water for at least two days at that point. So not only was he injured, he was dehydrated and a little underweight too. The only thing that worried me was that it felt like the punctures on his side were infected. He was running a slight fever as well.

Now, it's been a week that we've had him, and after just some good food and lots of water and rest he's up and bouncing around like a dog his breed should. However, it still feels like there's this pocket under where the puncture wounds are. The punctures aren't draining any pus or other fluid, and sren't hot to the touch, and it sounds like the other poster's have described, rice crispies ... or a wet whoopie cushion! So I'm glad to know I probably don't have anything to worry about. I will be keeping an eye on it and if it doesn't fade away in a few more days, I'll make sure he gets in to the vet's to make sure there's nothing seriously wrong with him.

So thank you so much for posting this article.

July 23, 2011 11:50 PM  
Anonymous Anonymous said...

THANK YOU...THANK YOU...THANK YOU! I can now finally go to sleep! I have been searching for hrs. online. My Cairn Terrior mix (15 lbs.) was attacked by our Am. Staff. (75 lbs.). I have to add that this attack happened after 3 yrs. of the little one attacking and biting the big one without the big one biting back. Anyway, the wounds to his neck were pretty severe and we thought he was dead for about five minutes. He suddenly came back to life as my children and I were sobbing. We still thought he wouldn't make it though. Almost a week later today and he went after 4 Golden Retrievers and a Black Lab! He does have a strange bark and "bubbles" under his skin covering his entire body. Until reading this post, despite his miraculous recovery and his feistyness, I was still preparing myself for the worst due to these "bubbles".
Thank again :-)

January 28, 2012 11:51 PM  
Anonymous Anonymous said...

My 11lb Shihtzu Zoe and my 70lb Staffordshire Nelly got into it 2 days ago. This happened when I wasn't home. When I got home I found Zoe with blood on her and bite marks on her neck and back. So I gave her a bath to clean her up. That is when I noticed the puncture wound under her chin. Also, when I was drying her off air was being expelled through the hole. I brought to the Emergency Vet. They cleaned her up, took X-Rays, gave her antibiotics and pain meds and I followed up the next day with their surgeon. They wanted her to stay over to monitor her but I really couldn't afford it!! The next day the surgeon examined her and said she did not need surgery or stitches but to be careful of her filling up with air. Of course, we weren't home an hour and she was all puffed out. So, back to the vet. They checked her vitals and everything was perfect. The vet said to keep her calm, not too much excitement and monitor her heart rate and breathing. Please say a prayer that we don't have to go back again before her next check up.

January 02, 2013 9:41 PM  
Anonymous Anonymous said...

My yorkie was attacked by a lurcher 3 days ago and has sub cutaneous emphysema. He has two what the vet calledd significant punctures to his throat but he isnt convinced that they are the source. xray tomorrow to confirm where its getting in. my poor little guy is so uncomfortable on top of the horrible injuries to his throat he has swelled up so bad he cant lie down for long... At night when he sleeping hiz breathing gets quite laboured ... what i wudnt do to have my little guy back to himself : (

February 12, 2013 1:21 PM  
Anonymous Anonymous said...

Thanks, all of your comments have greatly eased our minds. We have a Cocker Spaniel who was run over by a push bike on Sunday. She became quickly disfigured and awful gurgled breathing. We rushed her to the emergency vets. She had no lung puncture but the vet believed her air tract leaked and has now closed but she has loads of bubble wrap under her skin which does freak us out! It is definitely getting better but it has nearly been a week and still feels horrible but is definitely getting better.

July 06, 2013 12:06 PM  
Anonymous Anonymous said...

I just wanted to add our story, even though it has been 4+ years since the incident (so details are fuzzy):
Our German short haired pointer was about 4 years old and we left him at a pet boarding and daycare facility that we hadn't used before for a weeks vacation. When we returned, he was hoarse and his skin felt like bubble wrap, and he was terribly nervous, though the boarder smiled and told us what a great time he had enjoyed. We were very concerned and felt uneasy that she was not telling us all that really happened. :/
Of course we had our veterinarian check him out (who didn't seem unnerved by the symptoms, reassuringly) and the vet found no puncture wounds or injuries. Just wanted to make sure we helped him rest and recoup. I don't believe we were given any meds for him, and his bubbles disappated in a few days just as his bark returned. It is just such a weird and upsetting condition to find your dog in... I was just thinking about it and found this forum feeling like I should thank you all for your stories, and in payment, share ours.

Thank you,


January 05, 2015 12:28 PM  
Anonymous Cassandra said...

My 7 yearold chiweenie got violently kicked by a neighbor on Friday. We took him to emergency vet, and they diagnosed him with this. Prescribed tramadol for pain, and lots of rest. My concern is that he is not using the bathroom regularly. Did anyone else encourage thism

January 03, 2016 1:52 PM  
Anonymous Sarkis Karapetyan said...

My Boston terrier has been suffering from this for almost 3 weeks that we know of. I've spent 2k in vet bills with absolutely no positive results. His condition is not improving and seems to be getting worse. I have been giving him a lot of rest but with no avail. I can't afford surgery, what can I do? Can I drive him to Mexico to see a vet there? I'm so stressed.

June 09, 2016 1:41 AM  

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