Spontaneous pneumomediastinum (Hamman's syndrome): a rare cause of postpartum chest pain

Pneumomediastinum and Pericardium During Labour: A Report on a Rare Postpartum Phenomenon

Hamman's syndrome (HS) is characterised by spontaneous pneumomediastinum and subcutaneous emphysema. It is a rare phenomenon that can occur during labour. Its incidence is 1 in 100,000 births and predominantly affects young primiparous women with prolonged labour. Patients commonly present with subcutaneous emphysema, chest pain, and dyspnoea. We present the case of a 20-year-old primigravida female with no other medical history who had prolonged labour at 43 weeks gestation. Sudden-onset, right-sided cheek pain and swelling was noted immediately after delivery accompanied by pleuritic chest pain. Chest X-ray (CXR) and computed tomography (CT) demonstrated significant pneumomediastinum and pneumopericardium with subcutaneous emphysema extending to the neck. She was managed symptomatically in addition to antibiotics and discharged after three days with complete resolution of symptoms. No concerns were raised during the follow-up. HS is a rare phenomenon that can occur during labour, particularly in young primiparous females with a prolonged second stage. Radiological investigations in the form of CXR and CT are recommended to rule out life-threatening complications and other conditions that may require immediate management. HS occurs due to rupture of peripheral alveoli secondary to increased intrathoracic pressures from excessive Valsalva manoeuvre allowing air to dissect and enter into the mediastinum. Pneumopericardium in association with HS is extremely rare. It is particularly clinically important because it can cause cardiac tamponade requiring immediate surgical management. HS is otherwise a self-limiting condition and management is symptomatic only. Our case is unique due to the presence of pneumopericardium in association with HS, the fourth ever reported in the literature. Due to its rarity, the incidence of tamponade in this cohort of patients is yet to be delineated.

A Rare Complication during Vaginal Delivery, Hamman's Syndrome: A Case Report and Systematic Review of Case Reports

Background: Spontaneous pneumomediastinum (SPM) during pregnancy or labor is a rare event. We presented a case report and a systematic review of the literature to provide comprehensive symptoms, treatments, and complications analysis in the pregnant population affected by SPM. Methods: We conducted a comprehensive search of four databases for published papers in all languages from the beginning to 1 September 2021; Results: We included 76 papers with a total of 80 patients. A total of 76% patients were young primiparous, with a median age of 24 ± 5.4 years. The median gestational age was 40 ± 2.4 weeks, with a median duration of labor of 7.4 ± 4.2 h. In 86%, the ethnic origin was not specified. SPM develops in 55% of cases during the second stage of labor. Subcutaneous swelling and subcutaneous emphysema were present in 91.4%. Chest pain and dyspnea were present in 51.4% and 50% of the patients, respectively. We found that 32.9% patients had crepitus, and less common symptoms were dysphonia and tachycardia (14.3% and 14.3%, respectively). Oxygen and bronchodilators were used in 37.7% of the cases. Analgesics or sedatives were administered in 27.1%. Conservative management or the observation was performed in 21.4% and 28.6%, respectively. Antibiotics treatment was offered in 14.3%, whereas invasive procedures such as chest-tube drainage were used in just 5.7% of patients. There were no complications documented in most SPM (70.0%). We found that 16.7% of the SPM developed a pneumothorax and 5% developed a pneumopericardium.; Conclusions: In pregnancy, SPM occurs as subcutaneous swelling or emphysema during the second stage of labor. The treatment is usually conservative, with oxygen and bronchodilators and a low sequela rate. A universal consensus on therapy of spontaneous pneumomediastinum in pregnancy is necessary to reduce the risk of complications.

Facial swelling and dysphonia during labour: a case of Hamman's syndrome

We present the case of a previously fit and well 30-year-old primiparous woman who developed Hamman's syndrome during the second stage of labour. This is an unusual and peculiar condition, characterised by spontaneous pneumomediastinum and subcutaneous emphysema. The rarity of the condition means it can easily be misdiagnosed. Its exact aetiology is unknown, but it is believed that extreme Valsalva manoeuvre during prolonged or difficult labours may contribute to its development. Chest X-ray is the first investigation of choice in this presentation, followed by CT scanning. Fortunately, it is usually a benign condition that can be managed conservatively and resolved quickly, with no long-term effects and low risk of recurrence in future pregnancies. We are pleased to say that this case does not differ in this respect. It is, however, important to rule other more serious pathologies that present in a similar way, for example, Boerhaave syndrome, pneumothorax or pulmonary embolism.

Left-sided Neck Swelling: An Unusual Presentation of a Rare Disease

Pneumomediastinum describes air infiltrating into the soft tissues of the mediastinum. It may be classified as spontaneous or secondary. Spontaneous pneumomediastinum is a rare disease, which usually resolves without intervention. The acute onset of chest pain is the most common presenting complaint.  This article presents a case of spontaneous pneumomediastinum in a 19-year-old man with a short history of rapidly enlarging, painless swelling to the left side of his neck, followed by a discussion of the literature. The diagnosis was made following chest x-ray (CXR) and computed tomography (CT). There was no history of any precipitating event or any risk factors. He was managed conservatively and discharged with outpatient follow-up.  Management of spontaneous pneumomediastinum continues to vary and may benefit from the development of guidelines to standardise management in the future.

Pregnancy-associated Spontaneous Pneumomediastinum: A Contemporary Review

Spontaneous pneumomediastinum (SPM), also referred to as mediastinal emphysema, is defined as the presence of free air in the mediastinal cavity without a clear and identifiable cause. Spontaneous pneumomediastinum, in general, is a relatively rare condition, more so in the setting of pregnancy or labor. Clinically, SPM may present as dyspnea, chest pain, and subcutaneous swelling, which may be of serious concern in the setting of pregnancy. A comprehensive literature review revealed that the majority of patients are primiparas, of a younger age, and have term or longer durations of pregnancy. The second stage of labor was found to be most commonly associated with the development of SPM. The pathomechanism suggests that performing the Valsalva maneuver during the active stages of labor may play a role in the development of SPM. Once diagnosed, patients with SPM in pregnancy are admitted to the hospital, treated conservatively, and followed until resolution. SPM must be diagnosed and managed promptly due to rare but serious complications. In addition, dyspnea or chest pain with an unknown etiology should include SPM in the differential diagnosis, especially in the setting of pregnancy and labor.

Intrapartum spontaneous pneumomediastinum and surgical emphysema (Hamman's syndrome) in a 30-year-old woman with asthma

The authors report a case of a 30-year-old nulliparous woman with a prior medical history of asthma who developed intrapartum pneumomediastinum with surgical emphysema during the second stage of labour. She was managed conservatively with supportive care and there was complete resolution of symptoms within 4 days. Clinical and radiological findings were consistent with Hamman's syndrome (spontaneous pneumomediastinum). This case reiterates the possibility of childhood asthma or a family history of asthma as being an associated risk factor for Hamman's syndrome and reminds us of the need to distinguish such clinical findings from more important and potentially life-threatening conditions such as oesophageal rupture, pulmonary embolism and aortic dissection that can present with similar findings.