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Annales de Dermatologie et de Vénéréologie
Volume 137, n° 4
pages 294-296 (avril 2010)
Doi : 10.1016/j.annder.2010.02.016
Received : 10 Mars 2009 ;  accepted : 8 January 2010
Emphysème cutané iatrogène
Iatrogenic cutaneous emphysema
 

E. Blanchard a, , b , E. Wierzbicka-Hainaut a, S. Mallem c, P. Chasseuil b, G. Guillet a
a Service de dermatologie, hôpital La Milétrie, CHU de Poitiers, 2, rue de la Milétrie, BP 577, 86021 Poitiers cedex, France 
b Service de dermatologie, centre hospitalier de La Rochelle, hôpital Saint-Louis, rue du Dr-Schweitzer, BP 505, 17019 La Rochelle cedex 01, France 
c Service d’ophtalmologie, centre hospitalier de La Rochelle, hôpital Saint-Louis, rue du Dr-Schweitzer, BP 505, 17019 La Rochelle cedex 01, France 

Auteur correspondant.
Résumé
Introduction

Les plaies trachéales post-intubation peuvent entraîner un important emphysème cutané. Nous en rapportons un nouveau cas, révélé de façon remarquable par un gonflement des paupières avec pseudovésicules.

Observation

Une femme de 99 ans développait, dans les suites d’une intervention pour prothèse de hanche droite, un important gonflement du visage avec un aspect de pseudovésicules des paupières supérieures et inférieures. Il existait en outre une tuméfaction des membres supérieurs et du thorax. La radiographie thoracique montrait un important emphysème cutané de la paroi thoracique. La fibroscopie bronchique révélait une plaie de la face postérieure de la trachée. On retenait le diagnostic d’emphysème cutané secondaire à une plaie trachéale lors de l’intubation.

Discussion

Il s’agit d’un cas rare de plaie trachéale post-intubation orotrachéale chez une femme de 99 ans. La particularité de notre observation est liée au mode de révélation de l’accident. Devant l’apparition brutale de lésions pseudovésiculeuses des paupières en période postopératoire, le dermatologue ne doit pas méconnaître un emphysème cutané et il doit en rechercher d’autres signes à l’examen clinique du patient. Une fibroscopie bronchique doit être effectuée en urgence à la recherche d’une plaie trachéale.

The full text of this article is available in PDF format.
Summary
Background

Tracheal perforation following orotracheal intubation is a rare but classic complication of general anaesthesia, and marked cutaneous emphysema can occur. We report a rare case of facial cutaneous emphysema revealed by swelling with pseudovesicles on the eyelids.

Case report

A 99-year-old woman developed extensive facial swelling with pseudo-vesicles on the upper and lower eyelids following right hip replacement surgery. Swelling of the upper members and thoracic area was also seen. Chest X-rays showed marked cutaneous emphysema of the thoracic wall. Bronchial endoscopy revealed perforation of the posterior aspect of the trachea. The patient was presenting cutaneous emphysema as a result of post-intubation tracheal perforation.

Discussion

We report a rare case of cutaneous emphysema in a 99-year-old woman after tracheal perforation following orotracheal intubation. The significant feature of our case report is the actual manifestation of the condition. Our patient developed swelling of the eyelid with pseudovesicles. When confronted with sudden onset of pseudovesicles of the eyelids after surgery, dermatologists must not misdiagnose cutaneous emphysema and must examine their patient carefully for other clinical signs. Bronchial endoscopy should be undertaken immediately to investigate for tracheal perforation.

The full text of this article is available in PDF format.

Mots clés : Emphysème cutané, Plaie trachéale, Intubation orotrachéale, Paupières, Pseudovésicules

Keywords : Cutaneous emphysema, Tracheal perforation, Orotracheal intubation, Eyelids, Pseudovesicles




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