Case: An 80 year old female with a history of COPD presents to the hospital after a fall from standing onto her right side with respiratory distress. She repeatedly states feeling pressure to her face and “my face feels tight”. She appears to be in respiratory distress and is intubated for airway protection. Exam is notable for mild decreased breath sounds BL and for crepitus across her chest, bilateral arms, face, and back. You get a chest X-ray followed which is shown below.
What is the diagnosis? What is the name of the radiologic finding on CXR?
Diagnosis:
- The CT and CXR demonstrate bilateral pneumothoraxes with resulting extensive subcutaneous emphysema. In this case bilateral surgical chest tubes were placed with progressive resolution of pneumothoraxes and subcutaneous emphysema.
- Ginko leaf sign of the chest. Subcutaneous air tracks along the muscle fibers resulting in a branching pattern that resembles a ginkgo leaf and its branching veins.
Resources:
Fahrenhorst-Jones, Travis. “Ginkgo Leaf Sign (Subcutaneous Emphysema): Radiology Reference Article.” Radiopaedia, Radiopaedia.org, 17 May 2022, radiopaedia.org/articles/ginkgo-leaf-sign-subcutaneous-emphysema?lang=us.
Kukuruza, Kelsey, and Ayham Aboeed. “Subcutaneous Emphysema .” StatPearls, www.ncbi.nlm.nih.gov/books/NBK542192/.
