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A Case Report: Spontaneous Pneumomediastinum (Hamman's Syndrome)

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University of Florida Institutional Repository
Permanent Link: http://ufdc.ufl.edu/IR00003486/00001

Material Information

Title: A Case Report: Spontaneous Pneumomediastinum (Hamman's Syndrome)
Series Title: Bodhit AN, Stead LG. "A Case Report: Spontaneous Pneumomediastinum (Hamman's Syndrome)." Journal of Medical Cases 3.2 (2012): 144-145.
Physical Description: Journal Article
Creator: Bodhit, Aakash
Publisher: Journal of Medical Cases
Elmer Press Inc.
Place of Publication: Brossard, Quebec, Canada
Publication Date: April 2012
Copyright Date: 2012

Subjects

Subjects / Keywords: Spontaneous Pneumomediastinum; Hamman's Syndrome

Notes

Abstract: Spontaneous pnemomediastinum is a rare medical condition which usually occurs in young male patients with a history of inhalational drug use. Chest pain and dyspnea are common presenting symptoms, and precordial crunching sound on auscultation synchronous with heartbeats is a characteristic sign of this condition. Also known as Hamman's syndrome, it is usually self- limiting and without any complication or recurrence.
Acquisition: Collected for University of Florida's Institutional Repository by the UFIR Self-Submittal tool. Submitted by Aakash Bodhit.
Publication Status: Published

Record Information

Source Institution: University of Florida Institutional Repository
Holding Location: University of Florida
Rights Management: All rights reserved by the source institution.
System ID: IR00003486:00001

Permanent Link: http://ufdc.ufl.edu/IR00003486/00001

Material Information

Title: A Case Report: Spontaneous Pneumomediastinum (Hamman's Syndrome)
Series Title: Bodhit AN, Stead LG. "A Case Report: Spontaneous Pneumomediastinum (Hamman's Syndrome)." Journal of Medical Cases 3.2 (2012): 144-145.
Physical Description: Journal Article
Creator: Bodhit, Aakash
Publisher: Journal of Medical Cases
Elmer Press Inc.
Place of Publication: Brossard, Quebec, Canada
Publication Date: April 2012
Copyright Date: 2012

Subjects

Subjects / Keywords: Spontaneous Pneumomediastinum; Hamman's Syndrome

Notes

Abstract: Spontaneous pnemomediastinum is a rare medical condition which usually occurs in young male patients with a history of inhalational drug use. Chest pain and dyspnea are common presenting symptoms, and precordial crunching sound on auscultation synchronous with heartbeats is a characteristic sign of this condition. Also known as Hamman's syndrome, it is usually self- limiting and without any complication or recurrence.
Acquisition: Collected for University of Florida's Institutional Repository by the UFIR Self-Submittal tool. Submitted by Aakash Bodhit.
Publication Status: Published

Record Information

Source Institution: University of Florida Institutional Repository
Holding Location: University of Florida
Rights Management: All rights reserved by the source institution.
System ID: IR00003486:00001


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Case Report P ress Elmer Articles The authors | Journal compilation J Med Cases and Elmer Press | www.journalmc.org A Case Report: Spontaneous Pneumomediastinum (Hammans Syndrome) Aakash N. Bodhit a, b Latha G. Stead a Abstract Spontaneous pnemomediastinum is a rare medical condition which usually occurs in young male patients with a history of inhalational drug use. Chest pain and dyspnea are common presenting symp toms, and precordial crunching sound on auscultation synchronous with heartbeats is a characteristic sign of this condition. Also known as Hammans syndrome, it is usually selflimiting and without any complication or recurrence. Keywords: Spontaneous pnemomediastinum; Precordial crunch ing; Hammans syndrome Introduction Spontaneous pneumomediastinum is not so common medi cal condition seen in the Emergency Medicine department. It is estimated to be present in approximately 1 in 30,000 Emergency Department referrals [1]. Though it is a benign and self-limiting condition, it often leads to a number of in vestigations due to possibility of a potentially serious condi tion such as a rupture of any of the viscera or simply because of misdiagnosis. It rarely leads to any complication. The condition was described by Louis Hamman and hence it is also known as Hammans syndrome. Case Report A15 year old male patient was referred to our Emergency de partment, which is a part of an academic tertiary care medi cal facility. The referral was for the evaluation of subcutane ous emphysema. The patient had presented with dull resting chest pain, which was gradual in onset. After an hour of dull pain, the Manuscript accepted for publication January 27, 2012 a Department of Emergency Medicine, University of Florida College of Medicine, Gainesville, FL 32610, United States b Corresponding author: Aakash N. Bodhit, Department of Emergency Medicine,University of Florida College of Medicine, 1329 SW 16th St, PO Box 100186, Gainesville, FL 32610-0186, United States. doi:10.4021/jmc530w Figure 1. Chest xray (scout view) depicting lucency along left mediastinal border (arrow) indicating pneumomediasti num. Also note the subcutaneous emphysema on the right side (arrow head). 144 145

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Bodhit et al Articles The authors | Journal compilation J Med Cases and Elmer Press | www.journalmc.org nature of the pain changed to sharp with radiation to his throat. The patient went to an outside Emergency Room (ER) where he was evaluated for his chest pain. Vital signs were found to be within normal limits. Physical examina tion was unremarkable. Routine laboratory evaluations such as CBC, and Basic Metabolic Panel (BMP) revealed no ab normality. A chest xray examination was remarkable for presence of subcutaneous emphysema (Fig. 1). He was sub sequently transferred to our Emergency department without any further intervention. Patient was symptom free upon arrival to emergency de partment of our hospital. He denied any history of any trau ma, foreign body ingestion or prior history of such episodes. The vital signs were normal. General examination revealed well appearing male, who was alert, oriented, and in no acute distress. On systemic physical examination, palpable subcu taneous emphysema over the right trapezius muscle and neck on respiratory and cardiac examination. The 12lead electro cardiogram was without any rhythm or repolerization abnor malities. A CT scan of the chest was obtained. cutaneous emphysema as seen in the Fig. 2 (arrow ahead). There was additional evidence of extensive pneumomedias tinum (arrow in Fig. 2). There was no pneumothorax present. Also, no obvious esophageal or tracheolaryngeal perforation he was diagnosed as having Hammans syndrome. Patient was put under medical observation and monitored for a day and subsequently discharged to home without worsening of condition or any complications. Patient was followed up four days later and his emphysema was completely resolved by then. A chest xray on followup visit was normal. His sub sequent clinical course was normal. Discussion Spontaneous pneumomediastinum (Hammans syndrome) is a rare condition which is usually benign and non recurrent. It is known to be associated with transiently elevated intra alveolar pressure. Other causes of pneumomediastinum such as trauma (blunt or penetrating trauma to chest), forceful vomiting (Boerhaaves syndrome), medical procedures such esophagoscopy, bronchoscopy should be ruled out. In three retrospective analyses, it has been noted that young male patients are affected more often by this condi tion and it is associated with inhalational drug use [1-3]. It should be noted though that it has also been reported in women in the absence of inhalational drug use [4]. The most common presentation is chest pain and dys pnea, with subcutaneous emphysema being the most com mon sign. Palpable crepitus may be absent however [4]. Chest pain is usually retrosternal and it may radiate to neck or into the back. In almost all patients, vital signs are nor mal and they appear well and healthy. Precordial crunching sound synchronous with heartbeat is the characteristic sign, which is called Hammans sign. It is present in more than half the patients, though it was absent in this case. Treatment is expectant. Medical observation of a few hours or few days are required depending upon the patient symptoms and signs. The patients can be discharged safely as typically they do not develop any complications, nor do they have recurrence. 1. Newcomb AE, Clarke CP. Spontaneous pneumomedi Chest. 2005;128(5):3298-3302. 2. Panacek EA, Singer AJ, Sherman BW, Prescott A, Ruth erford WF. Spontaneous pneumomediastinum: clinical and natural history. Ann Emerg Med. 1992;21(10):12221227. 3. Kelly S, Hughes S, Nixon S, Paterson-Brown S. Spon taneous pneumomediastinum (Hammans syndrome). Surgeon. 2010;8(2):63-66. 4. Mohseni MM. Spontaneous pneumomediastinum. Int J Emerg Med. 2008;1(3):229-230. Figure 2. (arrow head) and extensive pneumomediastinum (arrow). 144 145