Orthopedics
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A 44-year-old woman with a history of borderline personality disorder, Hepatitis C, and multiple hospital admissions for cellulitis and cutaneous abscesses presented with pain of several days duration in her left upper extremity following getting her left arm "stuck" in a subway turnstile. The pain and swelling had progressively worsened following the injury. At the time of presentation the patient's temperature was 98.6 degrees F, heart rate was 82 beats/minute, blood pressure of 116/60, and an oxygen saturation of 98% on room air. ⋯ Aerobic, anaerobic, fungal, and acid-fast bacteria cultures taken during the operation revealed no final growth. The patient was stable throughout the hospitalization, remaining afebrile with a normal white blood cell count. The gas in the subcutaneous and subfascial layers was not caused by infection but presumably was due to factitious self-injection of air.