Our institution, Loyola University Medical Center, is a nationally recognized quaternary-care system with a 61-acre main medical center campus in the western suburbs of Chicago. It houses a level 1 trauma center with the ability to provide top hospital care in all medical specialties.

A 27-year-old male with polytrauma was prepped for an open reduction internal fixation (ORIF) of a distal radius. Previous surgeries during his hospitalization were uncomplicated. Ultrasound scanning for identifiable anatomy revealed progressive accumulation of edema in the subcutaneous tissue appearing as branching, anechoic striations that impart a lobulated “cobblestone” appearance (Figure 1). Physical examination and subsequent chest X-ray confirmed the same. Lucency was present along the mediastinum consistent with pneumomediastinum and significant subcutaneous emphysema obscuring relevant block anatomy (Figure 2).

Without any reasonable explanation concerning the extensive crepitus, we decided to defer this non-urgent procedure. Later that evening, a computed tomography (CT)...

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