Life-threatening delayed mediastinal and subcutaneous emphysema after general anesthesia in a rheumatoid arthritis patient: a case report

Background: Delayed mediastinal emphysema with subcutaneous emphysema after extubation is rarely reported in current literature. Symptomatic treatment is considered effective for management. Case presentation: We report a case of a 56-year-old female with longstanding rheumatoid arthritis under corticosteroid therapy who developed mediastinal emphysema with subcutaneous emphysema 2 days after recovering from general anesthesia for orthopedic surgery treating a femoral neck fracture. The patient received aggressive subcutaneous decompression and symptomatic management. Results: The patient’s condition improved after treatment. Based on computed tomography scan results, we hypothesize that the longstanding rheumatoid arthritis may have resulted in fragile lung tissue. Violent postoperative coughing likely caused rupture of small airways, leading to mediastinal emphysema. Conclusions: It is crucial to preoperatively assess the risk of airway injury in high-risk patients with longstanding rheumatoid arthritis. Delayed postoperative mediastinal emphysema should be carefully evaluated and managed aggressively to avoid exacerbation or life-threatening scenarios. Further research is warranted to elucidate the pathology and guide perioperative management in these patients.