Spontaneous pneumomediastinum: A report of two cases at a District General Hospital

2021 ◽  
pp. 1753495X2110192
Author(s):  
Nathanael Yong ◽  
Oladimeji Olowu
Keyword(s):  
Chest Pain ◽  
Rare Condition ◽  
District General Hospital ◽  
Valsalva Manoeuvre ◽  
Second Stage ◽  
Spontaneous Pneumomediastinum ◽  
Management Algorithm ◽  
Second Stage Of Labour ◽  
Management Approaches ◽  
Limiting Condition

Spontaneous pneumomediastinum is a rare condition thought to be caused by excessive Valsalva manoeuvre during the second stage of labour. Women with pneumomediastinum typically presents with chest pain or tightness, dyspnoea, and a tearing sensation around the neck. It is commonly diagnosed with a chest radiograph but further imaging may be necessary to exclude more sinister conditions with similar clinical features. We describe two cases of pneumomediastinum and the different management approaches with different multi-disciplinary input. It is often a self-limiting condition. We propose a management algorithm for women suspected to have pneumomediastinum during the intrapartum and postpartum period.

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

2020 ◽  
Vol 9 (4) ◽  
pp. 1735
Author(s):  
Marco Gentile ◽  
Mariaconcetta Zinna ◽  
Antonio Costanza ◽  
Andrea Remo ◽  
Giuseppe Sala ◽  
...  
Keyword(s):  
Rare Complication ◽  
Rare Condition ◽  
Medical Problem ◽  
Lateral View ◽  
X Ray ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Spontaneous Pneumomediastinum ◽  
Second Stage Of Labour ◽  
Chest X Ray

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.

scholarly journals An Interesting Case of Spontaneous Pneumomediastinum with Subcutaneous Emphysema following Oral Provocative Manoeuvre

2015 ◽  
Vol 7 (2) ◽  
pp. 93-96 ◽  
Author(s):  
CB Pratibha ◽  
Deepthi Satish ◽  
Suraj Gopal
Keyword(s):  
Foreign Body ◽  
Subcutaneous Emphysema ◽  
Rare Condition ◽  
Interesting Case ◽  
Valsalva Manoeuvre ◽  
Laryngeal Edema ◽  
Airway Compromise ◽  
Air Leak ◽  
Spontaneous Pneumomediastinum ◽  
Laryngeal Involvement

ABSTRACT Aim To discuss a case of spontaneous pneumomediastinum with pneumothorax with subcutaneous emphysema presenting with stridor due to laryngeal edema with relevant review of literature. Background Spontaneous pneumomediastinum is a rare condition that has been described in healthy individuals following Valsalva manoeuvre, excessive and prolonged cough or emesis. Laryngeal involvement in these cases has not been reported so far. Case description We present an interesting case of spontaneous pneumomediastinum with pneumothorax with pneumopericardium and cervicofacial emphysema with suspected ingestion of foreign body. In view of stridor due to laryngeal edema tracheostomy was done. No obvious cause for the air leak was found on further investigations. The foreign body sensation could have led to oral provocative manoeuvres by the patient causing increased intra-alveolar pressures and air leak. Conclusion Spontaneous pneumomediastinum with cervicofacial emphysema with pneumopericardium with laryngeal involvement is very rare. Tracheostomy is essential in case of airway compromise. A thorough evaluation for the underlying condition is essential to prevent further air leak. Clinical significance In a case of spontaneous pneumomediastinum with airway compromise due to involvement of the larynx, tracheostomy is essential to secure the airway and could also help in resolution of emphysema. How to cite this article Pratibha CB, Satish D, Gopal S, Balasubramanya AM. An Interesting Case of Spontaneous Pneumomediastinum with Subcutaneous Emphysema following Oral Provocative Manoeuvre. Int J Otorhinolaryngol Clin 2015;7(2):93-96.

scholarly journals Spontaneous pneumomediastinum – a rare cause of chest pain and dyspnoe in children

2021 ◽  
pp. e570
Author(s):  
Marcin Mikoś ◽  
Katarzyna Jończyk-Potoczna ◽  
Paulina Sobkowiak ◽  
Anna Bręborowicz ◽  
Edyta Nagła ◽  
...  
Keyword(s):  
Chest Pain ◽  
Respiratory Insufficiency ◽  
Genetic Material ◽  
Severe Pneumonia ◽  
Rare Condition ◽  
Bronchial Tree ◽  
Human Bocavirus ◽  
Esophageal Rupture ◽  
Benign Condition ◽  
Spontaneous Pneumomediastinum

Introduction. Spontaneous pneumomediastinum is a very rare condition in children. Nevertheless it should be considered in the differential diagnosis in patients who present with chest pain and dyspnoe.Aim. The aim of our study was to describe clinical presentation, management and outcomes of the paediatric patients with spontaneous pneumomediastinumMaterial and Methods. This was a retrospective analysis of the charts of all the patients who were admitted to the Department of Pneumonology, Paediatric Allergy and Clinical Immunology in a ten year period from 01.01.2011 till 31.12.2020 in whom spontaneous pneumomediastinum was diagnosed.Results. There were 11 children (7 females) with spontaneous pneumomediastinum. The median age of the children was 11 years (range 3 to 17.5 years). Most of the children presented to the hospital with chest pain, three children complained of the neck swelling and four children developed dyspnoe. Three children with the primary spontaneous pneumomediastinum had a history of physical exercise prior to the onset of symptoms. The secondary spontaneous pneumomediastinum occurred in two children with asthma and 4 children with pneumonia. Genetic material of human Bocavirus was identified in 3 cases. In 81.8% of children pneumomediastinum was accompanied by subcutaneous emphysema and in one case, in a child with severe pneumonia and respiratory insufficiency caused by Bocavirus with pneumorrhachis. In 10 children computed tomography was performed, bronchoscopy in 4 and esophagoscopy in two children. There was no evidence of esophageal rupture or bronchial tree rupture in any of our patients. Three children with pneumonia and pneumomediastinum developed respiratory insufficiency, two of these were treated with mechanical ventilation and one with High Flow Nasal Cannula oxygen therapy. All the children received oxygen. In one child surgical procedure was performed and the drain was inserted into mediastinal space in order to decompress it. Outcome was favourable in all children. Mean time to recovery was 10.6 ± 1.2 days. There was no recurrence of symptoms in any of our patients.Conclusions. Spontaneous pneumomediastinum in most cases is a benign condition, sporadically however it may progress rapidly, leading to respiratory insufficiency and warrant invasive management.

scholarly journals Spontaneous pneumomediastinum: experience in 18 patients during the last 12 years

2017 ◽  
Vol 43 (2) ◽  
pp. 101-105 ◽  
Author(s):  
Patrícia Dionísio ◽  
Luís Martins ◽  
Susana Moreira ◽  
Alda Manique ◽  
Rita Macedo ◽  
...  
Keyword(s):  
Chest Pain ◽  
Rare Condition ◽  
Tobacco Consumption ◽  
Sudden Increase ◽  
Precipitating Factors ◽  
Intense Exercise ◽  
Predisposing Factor ◽  
X Ray ◽  
Spontaneous Pneumomediastinum ◽  
Chest X Ray

ABSTRACT Objective: To characterize clinically all of the patients with spontaneous pneumomediastinum (SPM) admitted to an adult pulmonology ward in Lisbon, Portugal. Methods: This was a retrospective descriptive study of all adult patients (≥ 18 years of age) diagnosed with SPM between January of 2004 and September of 2015. Results: At least one predisposing factor was identified in most (88.9%) of the 18 patients who presented with SPM during the study period. With regard to precipitating factors, bouts of cough were present in 50.0% of the patients. Other precipitating factors included a sudden increase in tobacco consumption, inhaled drug use, occupational inhalation of varnish fumes, intense exercise, and vomiting. The most common complaints were dyspnea (in 83.3%) and chest pain (in 77.8%). Other complaints included cough, neck pain, dysphagia, and odynophagia. Subcutaneous emphysema was found in most of the patients. The diagnosis of SPM was based on chest X-ray findings in 61.1% of the patients. Conclusions: Although SPM is a rare condition, it should be considered in the differential diagnosis of chest pain and dyspnea. It can develop without a triggering event or conclusive findings on a chest X-ray, which is usually sufficient for diagnosis.

scholarly journals An Unexpected Case of Intrapartum Pneumomediastinum

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Drishti Madhok ◽  
Vinayak Smith ◽  
Erik Gunderson
Keyword(s):  
Nitrous Oxide ◽  
Subcutaneous Emphysema ◽  
Valsalva Maneuver ◽  
Rare Complication ◽  
Healthy Woman ◽  
Second Stage ◽  
Spontaneous Pneumomediastinum ◽  
Second Stage Of Labour

The dyad of spontaneous pneumomediastinum and subcutaneous emphysema is collectively known as Hamman’s syndrome. This rare complication is known to occur during the intrapartum period and its aetiology has been linked to the Valsalva maneuver in the second stage of labour. Nitrous oxide inhalation increases the risk. We present the case of a 21-year-old healthy woman who experienced these symptoms after nitrous oxide inhalation during the second stage of labour.

scholarly journals Hamman’s syndrome: spontaneous pneumomediastinum and subcutaneous emphysema during second stage of labour

2017 ◽  
Vol 6 (6) ◽  
pp. 2622
Author(s):  
Ying Yiing Lou
Keyword(s):  
Subcutaneous Emphysema ◽  
Early Recognition ◽  
Rare Complication ◽  
Anterior Chest Wall ◽  
Second Stage ◽  
Second Stage Of Labour ◽  
Chest X Ray ◽  
Surgical Emphysema ◽  
Future Pregnancy ◽  
Limiting Condition

Subcutaneous emphysema with pneumomediastinum in labour is also known as Hamman's Syndrome. Maternal pneumomediastinum associated with subcutaneous emphysema is a rare complication of pregnancy. The incidence rate being between 1:2000 and 1:10,000. Pneumomediastinum occurs most frequently in the second stage of labour in a healthy primiparous women with prolonged labour. A 29-year-old primigravida, who had no relevant medical history, had an uneventful spontaneous vaginal delivery at term. She used Entonox as analgesia in labour. She developed facial and neck oedema associated with mild breathing discomfort towards the end of her second stage. Crepitus was felt in her cheek, neck and anterior chest wall. Observations were stable including oxygen saturation. Chest X-ray demonstrated gross and extensive surgical emphysema across the chest and up into the neck and with no evidence of pneumothorax. She was managed conservatively and the subcutaneous emphysema was found to have considerably better within 24 hours. She recovered uneventfully and was discharged within 3 days of admission. A future pregnancy is planned. Hamman’s syndrome is generally a self-limiting condition. The key to successful management is early recognition followed by appropriate measures to prevent further complications in order to reduce the morbidity and mortality associated with this condition. Supportive measures alone may be the only requirement for resolution. Recurrence of the condition is rare but the appropriate management of subsequent pregnancies is unclear. Our case was appropriately managed with multidisciplinary input in the HDU on labour ward.

scholarly journals Spontaneous Pneumomediastinum in Labor

2017 ◽  
Vol 2017 ◽  
pp. 1-3 ◽  
Author(s):  
Mohamed Adnane Berdai ◽  
Said Benlamkadem ◽  
Smael Labib ◽  
Mustapha Harandou
Keyword(s):  
Subcutaneous Emphysema ◽  
Valsalva Maneuver ◽  
Rare Complication ◽  
Diagnostic Technique ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Spontaneous Pneumomediastinum ◽  
Major Interest ◽  
Chest X Ray ◽  
Limiting Condition

Spontaneous pneumomediastinum and subcutaneous emphysema also known as Hamman’s syndrome is a very rare complication of labor that is often related to the valsalva maneuver during the labor. In most case, Hamman’s syndrome is a self-limiting condition, rarely complicated unless there are underlying respiratory diseases. Chest X-ray can be a useful early diagnostic technique in severe clinical presentation. We report an uneventful pregnancy in a primigravid parturient, which was complicated in the late second stage of labor by the development of subcutaneous emphysema, pneumomediastinum, and mild pneumothorax. Spontaneous recovery occurred after four days of conservative management. This condition shows the major interest of labor analgesia especially locoregional techniques.

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