A 73-year-old woman, with a history of arterial hypertension, type 2 diabetes mellitus and obesity. She went to the Emergency Department for dyspnea, having been hospitalized with the diagnosis of decompensated heart failure with type 2 respiratory failure. During hospitalization, for the etiological study of a pleural effusion, a diagnostic thoracentesis was performed, where an empyema was objectified and a chest drain was placed and underwent fibrinolytic therapy and DNAse, having also completed antibiotic therapy with ceftriaxone and azithromycin. As an intercurrence of the chest tube placement, the patient developed grade V subcutaneous emphysema. Thoracic- abdominal-pelvic computed tomography (CT) scan revealed "exuberant bilateral cervical-thoraco- abdominal subcutaneous emphysema with inferior extension to the left and right iliac fossa reaching the inguinal region and exuberant mediastinal emphysema" (Image A). Two subcutaneous drains were placed in the anterior thoracic region along the 3rd intercostal space with significant improvement and almost complete resolution of emphysema in 2 weeks (Image B).