Subcutaneous Emphysema: Symptoms, Causes, and Recovery
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer
Subcutaneous emphysema is the accumulation of air in the layer under the skin, most commonly in the face, neck and chest, causing swelling and a crackling sensation called crepitus. Causes include surgery, intubation, chest injuries and infections. Treatment addresses the cause, often with oxygen therapy, and most people recover in about 10 to 14 days.
What the research says
Causes vary with how far the air has spread. In a retrospective study of 35 people with moderate to severe subcutaneous emphysema (mean age 53, 71% men), the most common cause was a collapsed lung on a background of COPD, along with surgery, in the most extensive cases, while rib-fracture trauma and medical procedures were the main causes in less extensive grades. Two small incisions below the collarbones were used to release trapped air (Aghajanzadeh et al., Indian J Surg, 2015) [2].
Air under the skin is common after some endoscopic procedures and is usually minor. A systematic review of 1,122 patients (22 studies) treated with peroral endoscopic myotomy for achalasia reported subcutaneous emphysema in 31.6% as a minor adverse event, while major events such as a mediastinal leak were rare (0.3%) (Patel et al., Dis Esophagus, 2016) [3].
A small leak can often be managed without surgery. A systematic review of 29 patients with ectopic air after transanal procedures (air most often in the retroperitoneum, then under the skin) found that 20 were treated conservatively and the air resolved in all cases; surgery was advised only for fluid collection or suture breakdown (Balla et al., Int J Surg, 2018) [4].
What is subcutaneous emphysema?
Subcutaneous emphysema is a rare medical condition characterized by air or gas within the subcutaneous layer, the deepest layer of the skin. It can occur anywhere on the body but is most frequently seen in the face, neck, and chest. [1] Cleveland Clinic reports that it affects just over 2% of the general population, and research it cites found an average age at diagnosis of 53, with about 70% of those affected being male. [1]
In many cases, subcutaneous emphysema is a temporary and harmless side effect of surgical procedures such as laparoscopic surgery, where gas is intentionally introduced into the body. [1] When it occurs spontaneously or after trauma, however, it can be an important indicator of an underlying health issue that needs prompt medical evaluation to prevent serious complications.
What are the symptoms of subcutaneous emphysema, including crepitus?
The two most common signs of subcutaneous emphysema are localized skin swelling (edema) and a unique sensation called crepitus. [1] Crepitus is a crackling or popping sound and feeling that occurs when pressure is applied to the affected skin, similar to stepping on dry snow or pressing on bubble wrap.
As the amount of trapped air increases, or if the underlying cause is severe, additional symptoms may develop. These depend on where the air is located and how it affects the surrounding structures.
What causes subcutaneous emphysema, and who is at risk?
Subcutaneous emphysema has many causes, from environmental factors to medical interventions. Barotrauma, which results from a sudden shift in air or water pressure, is a common cause among scuba divers. [1] Injuries to the chest, face, or sinuses can also let air leak into the skin layers. In rare cases it happens for no known reason.
Medical and surgical trauma is another frequent source, especially procedures involving the airways or the digestive tract.
Cause Category | Specific Examples |
|---|---|
Trauma and Injury | Barotrauma, collapsed lung (pneumothorax), and chest, face, or sinus injuries. [1] |
Medical Procedures | Intubation, mechanical ventilation problems, and bag-mask ventilation during CPR. [1] |
Surgical Factors | Laparoscopic surgery, feeding tube insertion, and gastrointestinal perforations. [1] |
Infections | Severe infections such as necrotizing fasciitis (flesh-eating bacteria). [1] |
What complications can subcutaneous emphysema cause?
Mild cases often resolve without major problems, but severe or untreated cases can lead to significant complications. If a large amount of air builds up, it can press on vital structures and cause breathing or circulation problems.
Complications of severe cases include a collapsed lung, compartment syndrome, tracheal compression (a narrowed windpipe), pacemaker failure, poor blood circulation to the brain, and other respiratory problems. [1] When an infection is the cause, the risk of life-threatening complications rises, including sepsis, kidney failure, acute respiratory distress syndrome (ARDS), tissue death (necrosis), delirium, and coma. [1] This is why early diagnosis and treatment are critical.
How is subcutaneous emphysema diagnosed and managed?
Healthcare providers use several tools to confirm air under the skin and find its source. The choice of test depends on your symptoms and the suspected cause. Common methods include X-rays, CT scans, and ultrasound, and a bronchoscopy may be performed when the airways are involved. [1]
The primary goal of treatment is to address the underlying cause. Once the source is managed, the body typically reabsorbs the trapped air naturally.
For mild cases, providers may use an oxygen concentrator, which allows you to breathe up to 95% pure oxygen and helps the body reabsorb the trapped air. [1] To release excess air, a provider may insert a chest tube, make small incisions below the collarbones, or use needles, catheters, or incisions in other parts of the body. [1] [2] Severe cases may require surgery or drains. [1] Pain medicines, an abdominal binder (a compression garment worn around the belly), and concentrated oxygen can ease discomfort. [1] Once treatment begins, symptoms typically go away in about 10 to 14 days. [1]
Conclusion
Subcutaneous emphysema is a rare but noteworthy condition and a visible sign of air escaping from internal structures. While it is often a manageable side effect of surgery, its appearance after trauma or together with breathing difficulties requires prompt medical attention. With early diagnosis and treatment of the underlying cause, the outlook is generally positive, and most people recover in about two weeks.
What are the next steps for subcutaneous emphysema?
If you notice unexplained swelling or a crackling sensation when you press on your skin, contact a healthcare provider immediately. Call 911 or go to the emergency room if the swelling spreads quickly, especially in the neck or face, or if you have trouble breathing, chest pain, or trouble swallowing or speaking. Prompt evaluation is the best way to make sure any underlying problem is addressed quickly and to reduce the risk of serious complications.
Frequently Asked Questions
1. What is subcutaneous emphysema?
Subcutaneous emphysema is a condition in which air gets trapped in the deepest layer of the skin, the subcutaneous layer.
2. What does crepitus feel like?
Crepitus is a crackling or popping sensation under the skin when you press on it, similar to pressing on bubble wrap or stepping on dry snow.
3. Is it a common condition?
Cleveland Clinic describes it as rare, affecting just over 2% of the general population.
4. Where does it usually occur?
Subcutaneous emphysema most commonly affects the face, neck, and chest, but it can happen anywhere on the body.
5. Can surgery cause it?
Yes. Some air commonly builds up under the skin after procedures such as laparoscopic surgery. This often clears up on its own and usually causes no noticeable symptoms.
6. What are the main causes?
Causes include injuries to the chest, face, or sinuses, infections, surgical and medical trauma, a collapsed lung (pneumothorax), and sudden pressure changes (barotrauma).
7. Is it an emergency?
Not always, but prompt medical evaluation is key. It can be a sign of a serious underlying problem, especially after an injury or when breathing or swallowing is affected.
8. How is it diagnosed?
Doctors use a physical exam and imaging such as X-rays, CT scans, and ultrasound. A bronchoscopy may be used when the airways are involved.
9. What is the treatment?
The main treatment is addressing the underlying cause. Mild cases may be treated with oxygen therapy, and excess air can be released with a chest tube, small incisions, needles, or catheters. Severe cases may need surgery or drains.
10. Does it go away on its own?
In mild cases, it often clears up as the body reabsorbs the air once the cause is treated.
11. How long does recovery take?
Most people recover in about 10 to 14 days after treatment begins. Cleveland Clinic notes that in one study the average recovery, even in severe cases, was 16 days.
12. Can it be painful?
Subcutaneous emphysema does not always cause pain, but swelling and discomfort can occur. Pain medicines, an abdominal binder, and concentrated oxygen may help.
13. What are the risks of leaving it untreated?
Complications can include a collapsed lung, breathing problems, tracheal compression, and compartment syndrome. If an infection is the cause, sepsis, kidney failure, and acute respiratory distress syndrome (ARDS) can occur.
14. Who is most likely to get it?
Research cited by Cleveland Clinic found an average age at diagnosis of 53, with about 70% of those affected being male.
15. Can it be prevented?
Subcutaneous emphysema usually occurs in situations that are out of your control, such as an injury or a medical procedure, so lifestyle changes generally cannot prevent it. If you notice symptoms, contact a healthcare provider right away.
Trusted External Resources
Related Reading
Pneumothorax: Understanding Collapsed Lung Causes and Care explains a collapsed lung, a common cause of air under the skin.
Pneumomediastinum: Symptoms, Causes, and Clinical Management covers air trapped in the chest center, which often occurs alongside it.
Thoracostomy (Chest Tube Insertion): Purpose, Procedure, Risks and Recovery describes the chest tube procedure used to drain air from the chest.
Rib Fracture: Symptoms, Causes, and Recovery Guide explains broken ribs, a chest injury that can let air escape.
References
Cleveland Clinic. Subcutaneous Emphysema. Cleveland Clinic. Last updated March 27, 2025. https://my.clevelandclinic.org/health/diseases/subcutaneous-emphysema
Aghajanzadeh M, Dehnadi A, Ebrahimi H, et al. Classification and management of subcutaneous emphysema: a 10-year experience. Indian J Surg. 2015;77(Suppl 2):673-677. PMID 26730086. https://doi.org/10.1007/s12262-013-0975-4
Patel K, Abbassi-Ghadi N, Markar S, et al. Peroral endoscopic myotomy for the treatment of esophageal achalasia: systematic review and pooled analysis. Dis Esophagus. 2016;29(7):807-819. PMID 26175119. https://doi.org/10.1111/dote.12387
Balla A, Quaresima S, Paganini AM. Ectopic air localizations after transanal procedures: a systematic literature review. Int J Surg. 2018;56:167-173. PMID 29936199. https://doi.org/10.1016/j.ijsu.2018.05.743
Medical Disclaimer
This article is for informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article. If you think you may have a medical emergency, call your doctor or emergency services immediately.
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