Subcutaneous emphysema is a physical finding that itself is usually perceived as benign yet rarely may, in and of itself, be life-threatening. We present an unusual case of a 67-year-old woman who developed delayed severe subcutaneous emphysema and tension pneumothorax from a rib fracture subsequent to a fall. We review the pathophysiology, manifestations and management options of this disorder. In patients whose clinical condition allows it, chest tube placement prior to intubation should be considered. Furthermore, positive end-expiratory pressure should be minimized. We present a case that illustrates how subcutaneous emphysema itself can be a potential cause of respiratory failure and tamponade physiology. In our case, a patient with traumatic subcutaneous emphysema developed respiratory failure and clinical deterioration after the introduction of positive pressure ventilation. In such rare scenarios, care should be taken to consider the absolute need for positive pressure ventilation without surgical decompression.

Extraperitoneal bleeding from the inferior epigastric artery (IEA) and its branches is a rare complication of blunt pelvic trauma; however, it can result in life-threatening hemorrhage, even in cases of minimally displaced fractures of the pelvic ring. We report the case of a patient who had post-traumatic pelvic hematoma and cardiovascular collapse caused by avulsion of the right pubic branch of the IEA related to undisplaced fractures of the pubic rami. CT scanning followed by angiography showed leakage of contrast from the IEA. Transcatheter arterial embolization was performed to successfully control the hemorrhage. There have been very few previous reports of IEA injury related to stable fractures of the pubic rami successfully treated by transcatheter arterial embolization.