Subcutaneous Emphysema?

Hi all,

My first post here so please be gentle ...

I've been on the hose for two weeks now great results ... Untreated AHI of +/- 60 came down to below 5 almost instantly, and I even had a zero AHI afternoon nap yesterday!

I am delighted with this outcome and I am still on a high from being well-rested the first time in 15 or 20 years.

I have not had any side effects, but this morning I noticed a patch of parallel, vertical lines on the left hand base of my neck ... sort of above the collar bone. I did a few minutes of googling and my lay diagnosis is subcutaneous emphysema. This would be indicated not only by the appearance, but also known lung barotrauma from a diving incident several years ago.

This is probably serious - the emphysema is not a problem in itself but the underlying problem has to be looked at. Before I'm off to see a medical specialist, I'd like to be prepared as best as I can. So a couple of questions:

- Anyone else with a similar problem? What was the outcome?
- I can imagine a lower pressure would reduce the incidence of SE. Are there effective ways to lower CPAP pressure (while maintaining efficacy)?
- Any sleep hygiene factors I may consider to alleviate the symptoms?

Many thanks!

Francois

I am a newbie too, and after a few days here I can assure you this is a beginner friendly board that as done nothing but help me -- and I am pretty sure that most of my posts have contained SOMETHING silly or naive in them

Did the barotrauma you experienced significant and what was that?

http://en.wikipedia.org/wiki/Subcutaneous_emphysema

Subcutaneous emphysema of the chest wall is commonly among the first signs to appear that barotrauma, damage caused by excessive pressure, has occurred, and it is an indication that the lung was subjected to significant barotrauma.[20] Thus the phenomenon may occur in diving injuries

[I gave up commercial diving due to a serious decompression illness [CNS] that apparently left me 'sensitized' so that even easy on dives I would get pretty bent.]

Almost everyone I heard of with mechanical pressure injuries seemed to suffer an air embolism which was of course immediately life threatening.

However, I never encountered anyone with a pneumothorax during my diving career (about 5 years) nor with these symptom so I know little to nothing about them.

One suggestion that might be helpful and speed up getting more useful comments than mine:

Post your machine type and the pressure(s) you are using.

Thank you Herb

I dive recreationally, not commercially. Like many beginner sport divers I saw the certifications path as a race and progressed far too quickly - I did my Rescue Diver course with less than 20 dives in my logbook. As a result I did not have a firm grasp of some of the basics and held my breath on ascent in a staged emergency situation. I've known about the lung rupture since then (+/- 2001) but symptoms have been very mild (occasional build-up of air under the ribs, mild pain in the left arm, slightly uncomfortable but nothing too serious). Now that I have started CPAP and it results in pneumothorax-related symptoms I have to get it sorted ... I am not giving up my sleep!

I have managed to find a pulmonologist / internist who is affiliated to a local sleep centre. Looks like just the right sort of doc to see!

Thanks again!

Maybe you just slept on the hose and the ridges left marks on your neck?

ScubaSleeper,

Yes, since you have found a "pulmonologist / internist who is affiliated to a local sleep centre" chances are you are on the right track.

If that doc doesn't seem knowledgeable about your type of injuries then try to find another. Likely pulmonologists hold the best chance for you, and if you seek another open the search to leading diving doctors, especially if you can find one who is also a pulmonologist.

You have a very specific and unusual condition that will make treatment more challenging and getting good advice more difficult.

Also, you should find out your numbers and perhaps post them, although getting help here should mostly wait for that specialist visit.

FYI: Preparing for commercial diving school in 1975 by pre-reading the texts and manuals, one of my first responses to the material was that it had just told me 100 new ways to screw up and get killed. (And sharks weren't even in the list. )

Good luck, and I hope it works out so you can get the apnea treatment you need and even perhaps heal or correct the injury you already have.

Julie wrote:Maybe you just slept on the hose and the ridges left marks on your neck?

Hey Julie, I think not ... but I'll certainly measure the pitch next time just to be sure

Herb, dive doc is a good idea and I'll give it a shot if don't come right. Problem is the specialist, who comes highly recommended, can only see me last week of Feb. Spoke to an internist friend (in another city, so not an option to see him) and he suggested going to the casualty ward for X-rays next time it happens, and then ask for a report to be sent to my GP and the sleep / pulmo doc.

Thanks again!

Press on the affected area. If it crunches like bubble wrap, go to the ED NOW.

I agree that you should treat this as urgent if it really is coming through a lung rupture, especially if the specialist appointment is put off for a month.

You could be aggravating the original injury.

Do the best you can to get an expert to investigate ASAP.

I will admit a serious knowledge deficit when it comes to barotrauma secondary to diving; but subcutaneous emphysema from CPAP?

SubQ emphysema is usually an ominous sign after serious trauma/surgery as air is pushed into tissues. The assessment finding is tissues that should be soft being slightly firm and feel like rice krispies popping under the skin.

I did a search and you learn something new every day I guess. It is possible to experience subQ emphysema from CPAP but it is usually associated with some kind of trauma or surgery that causes a break in usually intact tissues that allow air to be pushed into tissues. The cases they described involved facial trauma and root canal surgery. Something to keep in mind as I get root canals off and on.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769403/

http://www.ncbi.nlm.nih.gov/pubmed/9415951

SubQ emphysema can be serious and if it continues to accumulate near airways, it can squeeze them closed; an emergency.

I hope for your sake that you do not have this condition; obviously it needs to be seen sooner than later. The only cases I have seen have been right around chest tubes caused by small amounts of air traumatically being pushed into tissues during the insertion of the tube or pushed into the area by whatever penetrating trauma necessitated the chest tube.

I've seen it.

Call DAN http://www.diversalertnetwork.org at +1-919-684-2948

Tell them you might have subcutaneous emphysema and ask for a referral in your area.

Julie wrote:Maybe you just slept on the hose and the ridges left marks on your neck?

Julie, you got it on the money! I replicated the effect by taking a nap with the hose firmly wedged against my neck. So maybe I got ahead of myself with the whole SE think, but I am still concerned over possible complications from CPAP and my earlier lung damage ... so I am keeping the appointment to see the pulmonogist.

Thanks again for all the advice ... now I just need to create a new logon ... too embarrassed too use my old name again