After a tractor accident resulting in significant thoracic trauma, a 79-year-old man was brought to the emergency room. The patient, with a history of atrial fibrillation and anticoagulation, also had obstructive lung disease and lung emphysema. Primary evaluation revealed exuberant cervical, thoracic, and abdominal emphysema. A CT scan was performed that documented the massive subcutaneous emphysema and pneumothorax at the right hemithorax. A right-sided chest tube was inserted, and orotracheal intubation was carried out due to respiratory failure. The patient was subsequently admitted in the intensive care unit.

Figure 1

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