The presence of air in the subcutaneous tissue of an extremity constitutes a fearful finding because of the potential devastating consequences for both the extremity and life of the patient. The authors present herein a rare case of self-induced subcutaneous emphysema of the thigh in a young patient, which resulted in aggressive management consisting of IV antibiotics, hyperbaric oxygen therapy, and surgical debridement. Correlation of the various findings of the history, physical examination, imaging and laboratory findings is critical in order to avoid unnecessary radical treatment. In the absence of an apparent cause, factitious disorder should always be considered.