Emphysema is a progressive lung condition. It’s characterized by damage to the air sacs in your lungs and the slow destruction of lung tissue. As the disease progresses, you may find it increasingly difficult to breathe and engage in daily activity.

There are several subtypes of emphysema, including subcutaneous emphysema, bullous emphysema, and paraseptal emphysema.

Subcutaneous emphysema can occur when gas or air is trapped underneath the skin. It may be appear as a complication of COPD or as a result of physical trauma to the lungs.

Bullous emphysema can develop when a bulla, or air pocket, takes up space in your chest cavity and disrupts normal lung function. This is often known as vanishing lung syndrome.

Paraseptal emphysema can occur when your airways and air sacs become inflamed or damaged. Sometimes, it can develop as a complication of bullous emphysema.

Keep reading to learn more about subcutaneous emphysema and how it stacks up against bullous and paraseptal emphysema.

Subcutaneous emphysema is a type of lung disease where air or gas gets under your skin tissue. Although this condition commonly occurs in the tissue of the neck or chest wall, it can develop in other body parts. A smooth bulging will appear on the skin.

Subcutaneous emphysema is a rare condition that can occur after surgery of the thorax. However, many other factors contribute to disease development, including a collapsed lung and blunt trauma.

What are the symptoms?

Many of the symptoms of subcutaneous emphysema differ from most other types of emphysema.

The symptoms of subcutaneous emphysema include:

  • sore throat
  • neck pain
  • swelling of the chest and neck
  • difficulty breathing
  • difficulty swallowing
  • difficulty speaking
  • wheezing

What causes subcutaneous emphysema and who is at risk?

Unlike other forms of emphysema, subcutaneous emphysema typically isn’t caused by smoking.

The main causes include:

  • certain medical procedures, including thoracic surgery, endoscopy, and bronchoscopy
  • collapsed lung accompanied by a rib fracture
  • facial bone fracture
  • ruptured esophagus or bronchial tube

You may also be at risk for subcutaneous emphysema if you have:

  • certain injuries, such as blunt trauma, stabbing, or a gunshot wound
  • certain medical conditions, including whooping cough or forceful vomiting
  • snorted cocaine or breathed in cocaine dust
  • had your esophagus damaged by corrosives or chemical burns

How is subcutaneous emphysema diagnosed and treated?

If you’re experiencing symptoms of subcutaneous emphysema, go to the emergency room.

During your appointment, your doctor will perform a routine physical exam and assess your symptoms. Before performing additional testing, your doctor will touch your skin to see if it produces an abnormal crackling sound. This sound may be the result of gas bubbles being pressed through the tissues.

Your doctor may also order X-rays of your chest and abdomen to look for air bubbles and assess lung function.

Treatment will depend on what exactly caused the disease. They may provide you with a supplemental oxygen tank to help ease any shortness of breath.

In severe cases, a lung transplant may be necessary.

Bullous emphysema occurs when giant bullae develop in the lungs. Bullae are bubble-like cavities filled with fluid or air.

The bullae typically grow in the lungs' upper lobes. They often take up at least one-third of one side of the chest. Lung function may be impaired if the bullae become inflamed and rupture.

Doctors have dubbed bullous emphysema "vanishing lung syndrome" because the giant air sacs cause the lungs to look as if they're disappearing.

What are the symptoms?

The symptoms of bullous emphysema are similar to that of other types of emphysema.

These include:

  • chest pain
  • difficulty breathing
  • shortness of breath
  • wheezing
  • chronic coughing with phlegm production
  • nausea, loss of appetite, and fatigue
  • nail changes

Bullous emphysema can also lead to certain complications, such as:

  • infection
  • collapsed lung
  • lung cancer

What causes bullous emphysema and who is at risk?

Cigarette smoking is the primary cause of bullous emphysema. A 2012 study suggests that excess marijuana use can also be a cause of bullous emphysema.

You may be more at risk for bullous emphysema if you have any of the following genetic disorders:

How is bullous emphysema diagnosed and treated?

If you’re experiencing symptoms of bullous emphysema, consult your doctor.

During your appointment, your doctor will perform a physical exam and assess your symptoms.

To make a diagnosis, your doctor will test your lung capacity with a spirometer. They’ll also use an oximeter to measure the oxygen levels in your blood.

Your doctor may also recommend chest X-rays and scans to determine the presence of damaged or enlarged air sacs.

As with other forms of emphysema, bullous emphysema is treated with different types of inhalers. This can help alleviate any shortness of breath or difficulty breathing. In some cases, your doctor may recommend supplemental oxygen therapy.

A steroid inhaler may also be prescribed. This can help your symptoms. Your doctor may also prescribe antibiotics to control any inflammation and infection.

In severe cases, a lung transplant may be necessary.

Learn more: COPD vs. emphysema: Is there a difference? »

Paraseptal emphysema is characterized by swelling and tissue damage to the alveoli. Alveoli are tiny air sacs that allow oxygen and carbon dioxide to flow through your airways.

This form of emphysema usually occurs on the back part of the lung. It’s possible for paraseptal emphysema to progress into bullous emphysema.

What are the symptoms?

Symptoms of paraseptal emphysema include:

  • fatigue
  • coughing
  • wheezing
  • shortness of breath

In severe cases, paraseptal emphysema may result in a collapsed lung.

What causes paraseptal emphysema and who is at risk?

As with other forms of emphysema, paraseptal emphysema is often caused by cigarette smoking.

The condition is also closely linked to pulmonary fibrosis and other types of interstitial lung abnormalities. These abnormities are defined by progressive scarring of the lung tissue that's between and cushions the air sacs.

You may be more at risk for bullous emphysema if you have any of the following genetic disorders:

How is paraseptal emphysema diagnosed and treated?

The symptoms of paraseptal emphysema often go unnoticed until it’s too late. Because of this, the condition tends to get diagnosed after it has advanced.

During your appointment, your doctor will review your medical history and assess your symptoms. From there, your doctor may order a chest scan or X-ray to assess your lung function and look for visual abnormalities.

Paraseptal emphysema is treated much like other forms of the condition.

Your doctor will prescribe either a non-steroid or steroid inhaler. Non-steroid inhalers can help improve your ability to breathe.

In some cases, your doctor may recommend supplemental oxygen therapy. In severe instances, a lung transplant may be necessary.

There isn’t a cure for any form of emphysema, but it’s manageable. If you’re diagnosed with emphysema, certain lifestyle changes, such as quitting smoking, will be necessary to preserve your quality of life. Your doctor will work with you to develop a management plan that can reduce or alleviate your symptoms.

Your projected life expectancy will depend on your individual diagnosis. Talk with your doctor about what this may mean for you. Sticking to your treatment plan can help slow the progression of the disease.

Keep reading: Understanding emphysema treatments »

Emphysema is often preventable. In many cases, avoidable lifestyle factors determine its likelihood.

To reduce your risk, avoid:

  • smoking
  • using cocaine
  • airborne toxins, such as charcoal dust

If emphysema runs in your family, have your doctor run tests to determine your genetic risk of developing the disease.

In the case of subcutaneous emphysema, you should try to protect yourself against avoidable injuries. Bullous and paraseptal emphysema typically aren’t caused by physical trauma. If you're undergoing certain medical procedures, make sure to speak with your doctor about your risk of developing the rare condition.