Subcutaneous emphysema and pneumomediastinum following shoulder arthroscopy with brachial plexus block: a case report and review of the literature

A number of complications are associated with shoulder arthroscopic surgery. However rare, respiratory complications such as pneumomediastinum and related tension pneumothorax as well as spontaneous pneumothorax in patients undergoing shoulder arthroscopy by endotracheal intubation have been reported in the literature. Although the exact pathogenetic mechanisms remain undetermined, surgery-related factors as well as associated respiratory comorbidity have been hypothesized to intervene in the onset of respiratory complications. We report on one patient who developed subcutaneous and mediastinic emphysema after arthroscopic subacromial decompression performed by loco-regional anesthesia. Pathogenetic hypotheses including potential surgery- and anesthesia-related factors as well as associated respiratory comorbid illness are briefly discussed. Knowledge of potential pathogenetic variables may enable both surgeons and anesthesiologists to set up preventive and early treatment measures. Finally, patients' perception of arthroscopic surgery as a minimally invasive procedure might challenge the patient-surgeon relationship if respiratory complications occur that have not been included in the informed consent.