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      Hamman's syndrome (spontaneous pneumomediastinum presenting as subcutaneous emphysema): A rare case of the emergency department and review of the literature

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          Abstract

          Pneumomediastinum is a rare clinical entity that concerns the clinicians in the emergency department. We present a case of a patient with spontaneous pneumomediastinum (Hamman's syndrome) that presented to our hospital's emergency department with cervical subcutaneous emphysema. A conservative treatment with observation was performed. The patient after 24 hours of observation was discharged with a suggested follow-up.

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          Pneumomediastinum.

          Vasileios Kouritas, Konstantinos Papagiannopoulos, George Lazaridis … (2015)
          Pneumomediastinum is a condition in which air is present in the mediastinum. This condition can result from physical trauma or other situations that lead to air escaping from the lungs, airways or bowel into the chest cavity. Pneumomediastinum is a rare situation and occurs when air leaks into the mediastinum. The diagnosis can be confirmed via chest X-ray or CT scanning of the thorax. The main symptom is usually severe central chest pain. Other symptoms include laboured breathing, voice distortion (as with helium) and subcutaneous emphysema, specifically affecting the face, neck, and chest. Pneumomediastinum can also be characterized by the shortness of breath that is typical of a respiratory system problem. It is often recognized on auscultation by a "crunching" sound timed with the cardiac cycle (Hamman's crunch). Pnemomediastinum may also present with symptoms mimicking cardiac tamponade as a result of the increased intrapulmonary pressure on venous flow to the heart. The tissues in the mediastinum will slowly resorb the air in the cavity so most pneumomediastinums are treated conservatively.
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            Spontaneous Pneumomediastinum: Time for Consensus

            Sonu Sahni, Sameer Verma, Jinette Grullon … (2013)
            Pneumomediastinum (PM) is defined as the presence of free air in the mediastinal cavity. It is often regarded as a revealing sign of a more serious medical condition. PM is broken down into two categories, one, with an instigating event, referred to as secondary PM. The other is when free air is discovered in the mediastinal cavity without a clear etiology, referred to as spontaneous pneumomediastinum (SPM). Often misdiagnosed due to the vague nature of presenting symptoms, SPM must be part of the differential diagnosis of a chest pain patient to expedite discovery and if necessary, management. A MedLine/PubMED search was performed identifying all relevant articles with “SPM” in the title. Six case series were reviewed to determine what clinical scenario constitutes a possible case of SPM. Results showed that almost all patients with SPM exhibited some chest pain, but Hamman’s crunch was present in only one-fifth of patients. Patients with certain pre-existing pulmonary diseases showed a greater propensity for the presence of free air in the mediastinal cavity. SPM must be diagnosed and managed promptly due to rare, but serious complications and any chest pain with an unknown etiology should contain SPM in the differential diagnosis.
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              Assessment of spontaneous pneumomediastinum: experience with 12 patients.

              Jacques Jougon, Michel Ballester, Frédéric Delcambre … (2003)
              The aim of this study is to report a series of spontaneous pneumomediastinum in a population of young, tall, and thin patients with a history of thoracic hyper pressure, and to analyze the assessment required in such patients. A retrospective study of an unicentric series and a review of the literature from 1980 to 2002 were performed. Between December 1996 and January 2002, 12 patients (mean age, 25 years old; mean height, 172 cm; and mean weight, 63 kg) were admitted with spontaneous pneumomediastinum. In all patients, high intrathoracic pressure by cough or acute effort was the precipitating factor. Most frequent complaints were acute chest pain, asthenia, and subcutaneous emphysema. The following assessment was performed: chest roentgenogram in 12 of 12 patients (12/12); computer tomography (CT) scan in 8/12; bronchoscopy in 7/12; esophagoscopy in 6/12; esophagography in 2/12. Outcome was always uneventful without any recurrence. Hospital stay ranged from 0 to 6 days. The Medline research revealed that articles consist mainly of case reports. Two articles only report a multicentric series of 25 and 36 cases, respectively. No organ perforation was found either in our series or in our review of the literature. Spontaneous pneumomediastinum follows alveolar rupture in the pulmonary interstitium. The dissection of gas towards the hilum and mediastinum is produced by an episode of acute high intrathoracic pressure. It affects mostly young people, and this is the case in our series. Endoscopic thoracic assessment may be risky and is not always necessary. Chest CT or esophageal contrast study should be performed in case of diagnostic doubt of esophageal perforation.
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                Author and article information

                Contributors
                Paul Zarogoulidis
                Journal
                Journal ID (nlm-ta): Respir Med Case Rep
                Journal ID (iso-abbrev): Respir Med Case Rep
                Title: Respiratory Medicine Case Reports
                Publisher: Elsevier
                ISSN (Electronic): 2213-0071
                Publication date PMC-release: 11 December 2017
                Publication date Collection: 2018
                Publication date (Electronic): 11 December 2017
                Volume: 23
                Pages: 63-65
                Affiliations
                [a ]Department of Cardiothoracic Surgery, “Iaso” General Hospital of Athens, Athens, Greece
                [b ]Department of Pneumonology, 401 General Military Hospital of Athens, Athens, Greece
                [c ]Department of Cardiothoracic and Vascular Surgery, Westpfalz Klinikum, Academic Educational Hospital, Heidelberg University and Mainz University, Kaiserslautern, Germany
                [d ]Department of Cardiothoracic Surgery, Patra's Medical School, University of Patra, Patra, Greece
                [e ]Division of Pulmonology, Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Alexandra Hospital, Athens, Greece
                [f ]Department of Respiratory and Critical Care Medicine, Changhai Hospital, Second Military Medical University, Shanghai, China
                [g ]Surgery Department, Interbalkan European Medical Center, Thessaloniki, Greece
                [h ]1st University Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Alexandroupolis, Alexandroupolis, Greece
                [i ]Anatomy Department, Democritus University of Alexandroupolis, Alexandroupolis, Greece
                [j ]Pulmonary Department, “G. Papanikolaou” General Hospital, Aristotle University of Thessaloniki, Greece
                [k ]Pulmonary Department-Oncology Unit, “Theageneio” Cancer Hospital, Thessaloniki, Greece
                Author notes
                [∗ ]Corresponding author. pzarog@ 123456hotmail.com
                Article
                Publisher ID: S2213-0071(17)30318-0
                DOI: 10.1016/j.rmcr.2017.12.004
                PMC ID: 5730040
                PubMed ID: 29276676
                SO-VID: 0aa05b92-3ded-47d5-bee6-49c6c73a6095
                Copyright © © 2017 The Authors
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 30 September 2017
                Date revision received : 6 December 2017
                Date accepted : 9 December 2017
                Categories
                Subject: Case Report

                Keywords: hamman's syndrome,pneumomediastinum,emphysema,dyspnea
                Data availability:
                Keywords: hamman's syndrome, pneumomediastinum, emphysema, dyspnea

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