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A 46-year-old man, with history of asthma without regular medication, presented with persistent dyspnoea and wheezes. He received endotracheal intubation with conventional ventilator support for acute respiratory failure with severe acidosis. Acute desaturation developed on the next day. The following thoracic and abdominal CT disclosed severe subcutaneous emphysema (figure 1, short arrow), pneumomediastinum (figure 1, long arrow), pneumoperitoneum (figure 2, asterisk) and even pneumoscrotum (figure 3, arrowhead). After aggressive treatment with systemic steroids, the endotracheal tube was extubated 3 days later in a highly improved condition. The patient was discharged uneventfully, and had regular outpatient visits.
Contributors Y-HL and C-KP managed the patient. Y-HL prepared the manuscript and images. C-KP revised this article.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; internally peer reviewed.