Pneumothorax, Subcutaneous emphysema, Chest tube
Subcutaneous emphysema occurs when air gets into tissues under the skin. It occurs mainly in the neck, chest and face when air travel to these areas of the chest cavity through the fascia. Introducing the chest radiograph of a 73 year old male diagnosed with chronic pericardial effusion mass, intervened on a scheduled basis for pericardial window, and in the immediate postoperative period presents important in left chest subcutaneous emphysema associated with desaturation and tachycardia. Suspecting possible pneumothorax that can not be clearly distinguished in the test image, and the likely need for intubation to the serious clinical condition, chest tube placement, which successfully produces clinical improvement and patient decide. The main causes that we suspected in a subcutaneous emphysema are pneumothorax, broken tree traqueobronquial , esophageal rupture, necrotizing infections and dental procedures using air comprimido  elements, and to the possible need for applying positive pressure to the patient, as in this case , we will place a chest tube though not clearly distinguish the camera radiographic pneumothorax.
Figure 1: Pneumothorax and subcutaneous emphysema