DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20201256

Hamman’s syndrome: a case report of spontaneous pneumomediastinum after vaginal delivery

Marco Gentile, Mariaconcetta Zinna, Antonio Costanza, Andrea Remo, Giuseppe Sala, Pietro Catapano

Abstract


Spontaneous pneumediastinum (Hamman’s syndrome) is a rare pathology defined as the presence of free air in the mediastinum with subcutaneous emphysema without trauma or medical problem. It is also a rare complication of labour and delivery and it usually occurs in the second stage of labour. A twenty-six-year-old primigravida presented to our hospital at 39 weeks and 6 days in spontaneous labour. Two hours following the delivery the patient developed neck tightness and chest tenderness with palpation. Chest X-ray and CT scan revealed pneumomediastinum extending into the soft tissue of the neck. A conservative management was performed. Spontaneous pneumomediastinum is a rare condition with a reported incidence of less than 1:44000 and in the setting of pregnancy or labor 1:100000. Regarding pregnancy, the valsalva maneuvers produced in the second stage of labor has been implicated in the development of spontaneous pneumomediastinum. Chest X-ray (posteroanterior and lateral view) is the most important test to confirm the diagnosis. The Hamman’s syndrome has usually a benign course and the management in often conservative. A timely diagnosis of Hamman’s syndrome is necessary for patient safety and correct management, but most cases have a self-limiting course.


Keywords


Delivery, Hamman, Pneumomediastinum, Postpartum

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References


Hamman L. Spontaneous mediastinal emphysema. 1939. Bull Johns Hopkins Hosp. 1939;64:1-21.

Beynon F, Mearns S. Spontaneous pneumomediastinum following normal labour. BMJ Case Rep. 2011;2011:bcr0720114556.

Bilgin M, Kahraman C, Akcali Y. Spontan pnomomediasten. Toraks Dergisi. 2003;4:183-5.

Hamman L. Spontaneous Interstitial emphysema of the lungs. Trans Amer Ass Phys. 1937;52:311.

Panacek EA, Singer AJ, Sherman BW, Prescott A, Rutherford WF. Spontaneous pneumomediastinum: clinical and natural history. Ann Emerg Med. 1992;21(10):1222-7.

Duffy BL. Post-partum pneumomediastinum. Anaesth Intens Care. 2004;32(1):117-9.

Cho C, Parratt JR, Smith S, Patel R. Spontaneous pneumomediastinum (Hamman's syndrome): a rare cause of postpartum chest pain. BMJ Case Rep. 2015;2015:bcr1220103603.

Macia I, Moya J, Ramos R, Morera R, Escobar I, Saumench J, et al. Spontaneous pneumomediastinum: 41 cases. Eur J Cardiothorac Surg. 2007;31(6):1110-4.

Crean PA, Stronge JM, FitzGerald MX. Spontaneous pneumomediastinum in pregnancy. Case report. Br J Obstet Gynaecol. 1981;88(9):952-4.

Macklin M, Macklin C. Malignant interstitial emphysema of the lungs and mediastinum as an important occult complication in many respiratory diseases and other conditions: interpretation of the clinical literature in the light of laboratory experiment. Med. 1944;23:281-358.

Mahboob A, Eckford SD. Hamman’s syndrome: an atypical cause of postpartum chest pain. J Obstet Gynaecol. 2008;28(6):652-3.

Bonin MM. Hamman’ syndrome (spontaneous pneumomediastinum) in a parturient: a case report. J Obstet Gynaecol Can. 2006;28(2):128-31.

Majer S, Graber P. Postpartum pneumomediastinum (Hamman’s syndrome). CMAJ. 2007;177(1):32.

Amine NO, Lomiguen CM, Iftikhar A, Sahni S. Pregnancy-associated spontaneous pneumomediastinum: a contemporary review. Cureus. 2018;10(10):e3452.

Khurram D, Patel B, Farra MW. Hamman’s Syndrome: a rare cause of chest pain in a postpartum patient. Case Rep Pulmonol. 2015;2015:201051.

Sızlanan A, Akçay O. Pneumomediastinum after difficult vaginal delivery. Turk Thorac J. 2016;17(2):76-8.