After tracheostomy, if crackles are noted due to subcutaneous emphysema, what radiographic finding is typical?

• A. Tracheal shift from midline
• B. Hyperlucency in the soft tissues
• C. Scattered patchy infiltrates
• D. Diffuse pulmonary hyperlucency

Answer: (B)

After a tracheostomy, the presence of crackles due to subcutaneous emphysema is typically associated with hyperlucency in the soft tissues on radiographic imaging. This finding occurs because the presence of air within subcutaneous tissue reduces the density of that tissue, resulting in an increased radiolucency or transparency on imaging. As air accumulates in the soft tissues, it creates a distinct appearance that can be identified clearly on X-rays or CT scans.

Hyperlucency in the soft tissues is indicative of the underlying pathology related to subcutaneous emphysema, where air escapes from the tracheal lumen and enters the surrounding subcutaneous space. This contrasts with other potential radiographic findings that would indicate different processes, such as tracheal shift or inflammatory responses within the lungs that would appear as infiltrates. Understanding this concept is crucial for recognizing and diagnosing complications following a tracheostomy procedure.