Hamman's syndrome (spontaneous pneumomediastinum) in a parturient: a case report

Hamman's Syndrome after Vaginal Delivery: A Case of Postpartum Spontaneous Pneumomediastinum with Subcutaneous Emphysema and Review of the Literature

Hamman's syndrome is a rare condition that mostly affects young males, often with a predisposition to asthma. It includes the presence of free air in the mediastinum and subcutaneous emphysema with no other underlying cause such as trauma, infection, or administration of any sort of mask support with hyperpressure. It occurs spontaneously and often in association with a prolonged Valsalva maneuver. This might explain why there are some cases of Hamman's syndrome among young females giving birth. Here, we present a case report of a 24-year-old non-smoker primigravida with Hamman's syndrome. She presented with symptoms a few hours after an uncomplicated vaginal delivery at 40 + 1 weeks of pregnancy where the active phase of labor lasted for three hours with normal progress. The second stage lasted for 30 min, with no signs of distress on CTG. The symptoms (pain in the right ear, swelling and pain in the neck, chest tightness, shortness of breath, dysphagia, odynophagia, and pain in the upper thorax on the right side) and objective findings as subcutaneous crepitations in the neck, parasternal region, right axillary fossa, clavicle and over the chest resolved spontaneously after a few days of observation and conservative management. We also give a systemic review of reported cases since 2000 to provide an overview of the pathomechanism, symptoms, diagnostics, treatment, and management of this condition. Hamman's syndrome is a rare, usually benign, but potentially serious complication that can occur during the second stage of labor. Diagnostics include inquiring about typical symptoms, clinical examination, and chest x-ray or CT scan. Treatment is usually conservative with oxygen, bronchodilators, and pain relief. The recurrence rate is low and there is no contraindication to vaginal delivery in future pregnancies. However, it is suggested that physicians and midwives be cautious and consider a low threshold for instrumental delivery or cesarean section to avoid excessive Valsalva maneuvers.

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.

Spontaneous pneumomediastinum: A report of two cases at a district general hospital

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.

Post-partum Hamman's Syndrome

Hamman's syndrome is an uncommon complication of labor. Its diagnosis is based on clinical suspicion and CT imaging. It is often a benign and self-limiting condition occurring in healthy patients. The risk factors are nulliparity and a prolonged second stage of labor. Hamman's syndrome has life-threatening implications that underscore the importance of early diagnosis and management to avoid any difficulty. This paper discusses the case of a 21-year-old, healthy female without allergies who was admitted to the hospital in spontaneous labor at 40 weeks of gestation. During the second stage of labor, she developed Hamman's syndrome and presented with subcutaneous emphysema, which led to an emergency C-section. After a chest and cervical CT scan that showed extensive subcutaneous emphysema and a pneumomediastinum, the patient was admitted to the ICU.

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.

Pneumomediastinum following spontaneous vaginal delivery: report of a rare phenomenon

Pneumomediastinum is the presence of mediastinal air, which raises concern for life-threatening conditions such as esophageal perforation and mediastinitis. Here, we described the case of a young female with no previous past medical history, who developed spontaneous pneumomediastinum following uncomplicated spontaneous vaginal delivery (SVD) giving birth to a healthy newborn at full term. The incidence of benign pneumomediastinum following SVD is estimated at 1 in 100 000 deliveries. This case explores the etiology of this rare presentation, recommends essential investigations and advises on pertinent clinical considerations.

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.

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.

Spontaneous Pneumomediastinum in Labor

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.

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

We present a case of a 28-year-old primiparous woman with facial swelling followed by acute chest pain immediately after delivery. Chest radiograph revealed pneumomediastinum and surgical emphysema. She recovered well within 24 h of observation and conservative management. Postpartum spontaneous pneumomediastinum should be considered in the differential diagnosis of sudden-onset postpartum chest pain immediately or a few hours after delivery. It is a rare benign condition and usually resolves spontaneously without serious consequences. Chest X-ray is the single most important diagnostic test. It is important to rule out other serious and life-threatening conditions. Prolonged pushing, difficult labour and use of inhalational drugs place young primiparous women at higher risk. Recurrence is uncommon in subsequent pregnancy and management is unclear, although expectant management with epidural analgaesia to prevent recurrence in subsequent pregnancy is suggested.

Hamman's Syndrome: A Rare Cause of Chest Pain in a Postpartum Patient

Hamman's syndrome is a rare condition represented by spontaneous pneumomediastinum and subcutaneous emphysema. Excessive Valsalva maneuver during vaginal delivery and excessive retching, coughing, and straining are frequently reported causes. The incidence of Hamman's syndrome is believed to be 1 in 100,000 deliveries. The pathophysiology of this condition is rupture of alveoli and seepage of air through bronchovascular connective tissue. Diffusion of air to subcutaneous tissues results in subcutaneous emphysema. In most cases, it is a benign condition and resolves spontaneously. In life-threatening cases, a cardiac tamponade can ensue. Chest X-ray is a useful early diagnostic technique. We report a case of a twenty-four-year-old female who was diagnosed with Hamman's syndrome after prolonged, exhaustive labor.

Postpartum spontaneous pneumomediastinum 'Hamman's syndrome'

Spontaneous pneumomediastinum and subcutaneous emphysema (Hamman's syndrome) are rare but potentially dangerous complications of labour. The authors reported a case of a 23-year-old primigravida, admitted to our hospital for delivery after 40 weeks of pregnancy. She delivered a baby of 4.27 kg after 9 h from the start of labour. A few minutes after delivery, the patient developed dyspnoea and chest tightness, which made her doctor suspect pulmonary embolism. A chest X-ray and CT scan revealed pneumomediastinum and subcutaneous emphysema. The patient had been followed up for 3 days in our hospital, without specific therapy.

[Management of spontaneous pneumomediastinum in the adult: 14 cases and a review of the literature]

The authors report a series of 14 patients hospitalized for spontaneous pneumomediastinium between 1992 and 2006. They included 10 men and four women with an average age of 27.84 years. Dyspnoea dominated the symptoms. The pneumomediastinum was idiopathic in five patients and secondary in the other nine patients, involving an attack of severe asthma in half of the patients, polymyositis in one patient and idiopathic pulmonary fibrosis in one patient, respectively. The patients presenting polymyositis and pulmonary fibrosis died due to respiratory distress. The other patients benefited from asthma treatment or thoracic drainage, and were kept at rest. Their outcome was good. No cases of relapse were observed after an average follow up of 2.11 years.