Subcutaneous Emphysema of the Neck

 Mr. M. J., 18 years old and a known case of Asthmatic Bronchitis was under my care since 4-1-1989 for recurrent cough and wheezing since 4 years. He came on 17-2-89 with a H/o breathlessness since 2 days that had been gradually increasing till that evening, when he had a sudden pain in the chest (Rt. Side) followed by an increase in breathlessness. The presenting complaints were:

-          Chest pain (sternal region and right side)

-          < coughing³, inspiration, lying on back

-          > pressure³, supporting the chest, lying on the abdomen

-          Pain right side of the face, neck and right ear, < slightest movement, swallowing

-          Severe weakness- he actually collapsed in my clinic and had to be carried to the examination couch. (He was actually appearing for his higher secondary examinations and had not eaten for the past 3 days, partly due to his anxiety and partly due to the breathlessness.)

Examination findings:

Afebrile

Pulse: 100/ min., regular and good volume

Resp. rate: 28/ min.

B.P.: 110/70 mm Hg.

No cyanosis or edema

JVP: NR

Dehydration 1⁰

Resp. System: AP diameter > Transverse diameter

Trachea central

Crepitus on palpation of the neck and upper chest

Rhonchi ++

Alimentary System: Bowel sounds – N

D- Subcutaneous (surgical) emphysema of the neck and chest due to a ? ruptured emphysematous bulla of the lung

 Treatment and Follow Up:

17-2-1989 (8.00 p.m.) The patient was given Bryonia 200, 1 dose, and sent for an urgent X-ray of the chest (PA view) which confirmed the clinical diagnosis. He was immediately admitted to Mumbadevi Homeopathic Hospital. Since he was unable to swallow and in view of his dehydration, he was put on Intra-Venous (IV) Fluids for the first 24 hours. The ENT surgeon was informed about this patient and was asked to be available for an urgent tracheostomy, in case his condition worsened. Bryonia 200 was continued 2 hourly.

18-2-1989 Pain +; breathlessness slightly > ]: Bryonia 1000, 2 hourly.

19-2-1989 The patient was on Bryonia 1000 and was soon able to swallow.

20-2-1989 Neck movements speedily improved.

23-2-1989 The patient was almost normal.

24-2 1989 Discharged.

(See the X-ray plates of 17-2-89, 20-2-89 and 24-2-89)

He was given 2 doses of Pyrogen 1000 on 20-2-1989 for fever with chilliness that was attributed to thrombophlebitis of the forearm veins (IV Fluids). Hamamelis ointment was prescribed for local application over the inflamed vein, which resolved the inflammation in just 6 hours.

 Discussion: This was a case of bronchial asthma with emphysematous changes in the lungs. An emphysematous bulla probably ruptured leading to the presenting complaints. The remedy Bryonia was obvious since the modalities and the location (including the side) were similar. It is important to note that in this acute and potentially life threatening case, homeopathy was able to help the patient swiftly (just 1 week) and without surgical intervention. A patient managed with the conventional (allopathic) line of treatment would have required at least 2-3 weeks for recovery.

This case was first published in the Indian Journal of Homoeopathic Medicine (www.holisticfoundation.com), Vol. 26, No. 1. January-March 1991 issue.