Subcutaneous emphysema after blunt anterior neck trauma most strongly suggests injury to which structure?

• A. Fractured larynx
• B. Pneumothorax
• C. Ruptured esophagus
• D. Carotid artery injury

Answer: (A)

Airway injury is the key idea here. Subcutaneous emphysema in the neck means air has leaked into the soft tissues, and when the trauma is blunt and focused in the front of the neck, the most likely source is the airway itself. The larynx sits right at the anterior neck, and a fracture of its cartilaginous framework can disrupt the airway and mucosa, allowing air from the trachea to dissect into the surrounding tissue. That air trapped under the skin produces the characteristic crackling feeling (crepitus) and swelling you’d notice.

Pneumothorax can cause air to escape into tissues as well, but the pattern of neck subcutaneous emphysema after anterior neck trauma points most strongly to an injury of the larynx. Esophageal rupture and carotid artery injury don’t fit the presentation as cleanly: esophageal injuries are less directly linked to blunt neck trauma in a way that produces isolated neck emphysema, and carotid injury presents with bleeding or neurologic signs rather than air in the neck tissues.