{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T11:10:03Z","timestamp":1756379403339,"version":"3.44.0"},"reference-count":8,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,11,30]]},"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:p>A 44-year-old man was admitted after being found suspended by his ankles from a bridge for 5\u2009days. The events leading to it was not clearly known initially. On examination, the patient was hypotensive and hypothermic, airway was oedematous and both lower limbs were mottled with dusky feet. Both foot pulses were impalpable, with prolonged capillary refill time and sensation barely present. Doppler signals were not heard in the feet, but groin pulses and popliteal signals were present. On CT, the patient had bilateral pneumothoraxes, extensive subcutaneous emphysema throughout the body from the subcutaneous tissue of the scalp to both lower limbs and pneumomediastinum and pneumoperitoneum. CT angiogram showed opacification up to proximal crural vessels and absence beyond. After multispeciality input and optimisation of his physiology, he underwent bilateral below knee amputations as they were non-salvageable.<\/jats:p>","DOI":"10.1136\/bcr-2021-247433","type":"journal-article","created":{"date-parts":[[2021,12,30]],"date-time":"2021-12-30T08:42:26Z","timestamp":1640853746000},"page":"e247433","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Extensive subcutaneous emphysema from scalp to lower limbs in a 44-year old"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2315-0744","authenticated-orcid":false,"given":"Balamrit Singh","family":"Sokhal","sequence":"first","affiliation":[{"name":"Medical School, Keele University, Keele, Staffordshire, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sowmya","family":"Prasanna Kumar Menon","sequence":"additional","affiliation":[{"name":"Medical School, Keele University, Keele, Staffordshire, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harrypal","family":"Panesar","sequence":"additional","affiliation":[{"name":"Royal Stoke University Hospital, Stoke-on-Trent, Stoke-on-Trent, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sriram","family":"Rajagopalan","sequence":"additional","affiliation":[{"name":"Medical School, Keele University, Keele, Staffordshire, UK"},{"name":"Royal Stoke University Hospital, Stoke-on-Trent, Stoke-on-Trent, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,12,30]]},"reference":[{"key":"2025082803443879000_14.12.e247433.1","unstructured":"Kukuruza K , Aboeed A . Subcutaneous emphysema. Treasure Island (FL): StatPearls, 2021."},{"key":"2025082803443879000_14.12.e247433.2","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1007\/s12262-013-0975-4","article-title":"Classification and management of subcutaneous emphysema: a 10-year experience","volume":"77","author":"Aghajanzadeh","year":"2015","journal-title":"Indian J Surg"},{"key":"2025082803443879000_14.12.e247433.3","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1984.00350190143024"},{"key":"2025082803443879000_14.12.e247433.4","first-page":"bcr2013201127","article-title":"Subcutaneous emphysema","volume":"2014","author":"Chotirmall","year":"2014","journal-title":"Case Rep Child Meml Hosp Chic"},{"key":"2025082803443879000_14.12.e247433.5","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1007\/s13665-021-00272-4","article-title":"The management of subcutaneous emphysema in pneumothorax: a literature review","volume":"10","author":"Melhorn","year":"2021","journal-title":"Current Pulmonology Reports"},{"key":"2025082803443879000_14.12.e247433.6","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1016\/j.ijscr.2018.01.018","article-title":"Management of extensive surgical emphysema with subcutaneous drain: a case report","volume":"44","author":"Tran","year":"2018","journal-title":"Int J Surg Case Rep"},{"key":"2025082803443879000_14.12.e247433.7","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-198509001-00090"},{"key":"2025082803443879000_14.12.e247433.8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2018\/3103061","article-title":"A case report of acute airway compromise due to subcutaneous emphysema","volume":"2018","author":"Olmstead","year":"2018","journal-title":"Case Rep Med"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-247433","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T10:44:49Z","timestamp":1756377889000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-247433"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12]]},"references-count":8,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2021,12,30]]},"published-print":{"date-parts":[[2021,12]]}},"alternative-id":["10.1136\/bcr-2021-247433"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-247433","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2021,12]]}}}