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Olafsen-Bårnes K, Kaland MM, Kajo K, Rydsaa LJ, Visnovsky J, Zubor P. Hamman's Syndrome after Vaginal Delivery: A Case of Postpartum Spontaneous Pneumomediastinum with Subcutaneous Emphysema and Review of the Literature. Healthcare (Basel) 2024; 12:1332. [PMID: 38998866 PMCID: PMC11241036 DOI: 10.3390/healthcare12131332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 06/30/2024] [Accepted: 07/01/2024] [Indexed: 07/14/2024] Open
Abstract
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.
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Affiliation(s)
| | - Marte Mari Kaland
- Department of Obstetrics and Gynecology, Helgeland Hospital, 8802 Sandnessjøen, Norway
| | - Karol Kajo
- Department of Pathology, St. Elisabeth Cancer Institute, 81250 Bratislava, Slovakia
| | - Lars Jakob Rydsaa
- Department of Radiology, Helgeland Hospital, 8802 Sandnessjøen, Norway
| | - Jozef Visnovsky
- Faculty of Health Care, Catholic University, 03401 Ruzomberok, Slovakia
- VISNOVSKI Ltd., 03601 Martin, Slovakia
| | - Pavol Zubor
- Department of Obstetrics and Gynecology, Helgeland Hospital, 8802 Sandnessjøen, Norway
- OBGY Health & Care Ltd., 01001 Zilina, Slovakia
- Department of Obstetrics and Gynecology, Nordland Hospital, 8450 Stokmarknes, Norway
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Zonnebeld N, Broos PPHL, Engelen SME, Vissers YLJ, de Loos ER. Pneumomediastinum in late pregnancy: a case report and review of the literature. Acta Chir Belg 2021; 123:301-304. [PMID: 34474633 DOI: 10.1080/00015458.2021.1975972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Pneumomediastium is a rare complication of pregnancy or labor. METHODS Here, we report our findings in a case report (gravid 5, para 2, gestational age 33 + 4 weeks) and narratively review the current literature on pneumomediastinum in pregnancy or labor. RESULTS Our case is the first case that experienced pneumomediastinum after relatively limited exposure to barotrauma in the current pregnancy. Other reports describe pneumomediastinum after hyperemesis gravidarum or during labor. Treatment is usually conservatively due to the trauma mechanism of barotrauma to the alveoli. CONCLUSION Physicians should be aware of the possibility of pneumomediastinum in pregnant women with acute thoracic pain in cases of (previous) hyperemesis gravidarum or during labor.
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Affiliation(s)
- N. Zonnebeld
- Department of Surgery, Zuyderland medical center, Heerlen, The Netherlands
| | - P. P. H. L. Broos
- Department of Surgery, Zuyderland medical center, Heerlen, The Netherlands
| | - S. M. E. Engelen
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Y. L. J. Vissers
- Department of Surgery, Zuyderland medical center, Heerlen, The Netherlands
| | - E. R. de Loos
- Department of Surgery, Zuyderland medical center, Heerlen, The Netherlands
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Scarborough A, Kemp O, Scarborough O. Spontaneous pneumomediastinum secondary to hyperemesis gravidarum: A case report and principles of recognition and management. Case Rep Womens Health 2020; 28:e00257. [PMID: 33088722 PMCID: PMC7562960 DOI: 10.1016/j.crwh.2020.e00257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 09/15/2020] [Accepted: 09/29/2020] [Indexed: 11/12/2022] Open
Abstract
Pneumomediastinum is the presence of aberrant air in the mediastinum and is most commonly caused by oesophageal or alveolar rupture. Hyperemesis gravidarum is persistent nausea and vomiting before the 20th week of pregnancy and can increase intra-thoracic pressure, precipitating pneumomediastinum. A 22-year-old patient presented with hyperemesis gravidarum in the 6th week of pregnancy. During her hospital admission, she developed chest pain, and imaging showed pneumomediastinum. Endoscopy excluded oesophageal perforation, a diagnosis of spontaneous pneumomediastinum was made, and her symptoms improved with conservative management. This case demonstrates how oesophageal perforation and spontaneous mediastinum can present in similar fashion. Oesophageal perforation has high morbidity and mortality and it is vital to identify it early. It is therefore important that clinicians are aware of pneumomediastinum as a potential complication of hyperemesis gravidarum and exclude oesophageal perforation in these individuals. Pneumomediastinum is a rare complication of Hyperemesis Gravidarum. The first priority of management of pneumomediastinum in pregnancy is to rule out oesophageal rupture Once oesophageal rupture has been excluded, management for spontaneous pneumomediastinum can commence. Spontaneous pneumomediastinum can often be treated conservatively.
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Tzeng CH, Chen WK, Lu HC, Chen HH, Lee KI, Wu YS, Lee FY. Challenges in the diagnosis of Boerhaave syndrome: A case report. Medicine (Baltimore) 2020; 99:e18765. [PMID: 31914100 PMCID: PMC6959951 DOI: 10.1097/md.0000000000018765] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Acute chest pain remains one of the most challenging complaints of patients presenting to emergency departments (EDs). The diverse etiologies of chest pain frequently lead to diagnostic and therapeutic challenges. Esophageal perforation is a rare but potentially life-threatening disease. It results in delayed diagnosis and an estimated mortality risk of 20% to 40%. Prompt diagnosis and immediate therapeutic interventions are key factors for a good prognosis. PATIENT CONCERNS Case 1 involved a 66-year-old man who presented to the ED with acute chest pain radiating to the back and hematemesis. Emergent contrast thoracic computerized tomography (CT) indicated the presence of a massive pneumothorax with pleural effusion. The continuous drainage of a dark-red bloody fluid following emergent thoracic intubation led to the discovery that the patient had experienced severe vomiting after whiskey consumption before admission to the hospital. Re-evaluation of the CT indicated spontaneous pneumomediastinum, whereas barium esophagography confirmed the presence of an esophageal perforation. Case 2 involved an 18-year-old Vietnamese man admitted to our ED with acute chest pain and swelling of the neck after vomiting due to beer consumption. A chest x-ray indicated diffuse subcutaneous emphysema of the neck and upper thorax. Contrast CT indicated pneumomediastinum with extensive emphysema and air in the paraspinal region and spinal canal. DIAGNOSES Both of the 2 cases were diagnosed as spontaneous perforation of the esophagus (Boerhaave syndrome [BS]). INTERVENTIONS Case 1 received surgical interventions, whereas case 2 decided not to avail our medical services. OUTCOMES Case 1 was discharged after a good recovery. Case 2 lost to follow-up. LESSONS We recommend all physicians in the ED to raise their index of suspicion for BS when dealing with patients having acute chest pain, dyspnea, confirmed pneumothorax, or newly-developed pleural effusion.
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Affiliation(s)
- Ching-Hsuane Tzeng
- Department of Emergency Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation
| | - Wei-Kung Chen
- Department of Emergency Medicine, Trauma and Emergency Center, China Medical University Hospital, Taichung
| | - Huei-Chun Lu
- Department of Emergency Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation
| | - Hsin-Hung Chen
- Department of Emergency Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation
| | - Kuan-I Lee
- Department of Emergency Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation
- Department of Emergency Medicine, School of Medicine, Tzu Chi University
| | - Yung-Shun Wu
- Department of Emergency Medicine, Mennonite Christian Hospital, Hualien, Taiwan (R.O.C.)
| | - Feng-You Lee
- Department of Emergency Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation
- Department of Emergency Medicine, School of Medicine, Tzu Chi University
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Dinberu MT, Mohammed MA, Tekelab T, Yimer NB, Desta M, Habtewold TD. Burden, risk factors and outcomes of hyperemesis gravidarum in low-income and middle-income countries (LMICs): systematic review and meta-analysis protocol. BMJ Open 2019; 9:e025841. [PMID: 30948589 PMCID: PMC6500362 DOI: 10.1136/bmjopen-2018-025841] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Hyperemesis gravidarum (HG) is a pregnancy condition characterised by excessive nausea and vomiting resulting in dehydration, weight loss and serious adverse pregnancy outcomes including termination of pregnancies. Even though evidence in low-income and middle-income countries (LMICs) is limited, the prevalence of HG in pregnancy ranges from 0.3% to 10.8%. With this systematic review and meta-analysis, we aim to determine the prevalence/burden, risk factors, and maternal and perinatal outcomes of HG in LMICs. METHODS PubMed, CINAHL, EMBASE, EBSCO, Ovid maternity and infant care databases, Cochrane Database of Systematic Reviews, Web of Science and SCOPUS databases will be searched. Reference lists of selected articles will be assessed in order to identify other potential studies of interest. Observational studies and (non) randomised controlled trials conducted from January 2000 to September 2018 in LMIC will be included. A weighted inverse-variance meta-analysis using fixed-effects and random-effects model will be done to generate a pooled estimate. Funnel plot and Egger's regression statistical test will be applied to check publication bias. Heterogeneity among studies will be checked using Τ2 to determine dispersion. Moreover, meta-regression analysis will be performed to investigate the source of heterogeneity. STATA V.14 will be used to analyse the data. ETHICS AND DISSEMINATION Formal ethical approval and patient consent are not required; as primary data collection will not be employed. The result will be published in a peer-reviewed scientific journal and will be presented at scientific conferences and public press. PROSPERO REGISTRATION NUMBER CRD42018096284.
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Affiliation(s)
| | | | - Tesfalidet Tekelab
- Department of Nursing and Midwifery, Wollega University, Nekemte, Ethiopia
| | - Nigus Bililign Yimer
- Department of Midwifery, College of Medicine and Health science, Woldia University, Woldia, Ethiopia
| | - Melaku Desta
- Department of Midwifery, Debre Markos University, Debre Markos, Ethiopia
| | - Tesfa Dejenie Habtewold
- Department of Nursing, Debre Berhan University, Debre Berhan, Ethiopia
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Spontaneous Pneumomediastinum and Subcutaneous Emphysema following Cocaine Inhalation and Ecstasy Ingestion. Case Rep Otolaryngol 2019; 2019:6972731. [PMID: 30918737 PMCID: PMC6409058 DOI: 10.1155/2019/6972731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/16/2019] [Accepted: 02/04/2019] [Indexed: 11/18/2022] Open
Abstract
Spontaneous pneumomediastinum (SPM) and subcutaneous emphysema are rare complications of illicit drug abuse. Thorough history, examination, and investigations are required to rule out fatal complications such as oesophageal perforation. We present a case of a 21-year-old male presenting with pleuritic chest pain one day after cocaine inhalation and ingesting ecstasy. Conservative supportive management is appropriate when this occurs spontaneously without radiological evidence of visceral perforation.
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Whelan S, Kelly M. Pneumomediastinum following a prolonged second stage of labor - an emphasis on early diagnosis and conservative management: a case report. J Med Case Rep 2017; 11:313. [PMID: 29110705 PMCID: PMC5674236 DOI: 10.1186/s13256-017-1482-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 10/01/2017] [Indexed: 02/05/2023] Open
Abstract
Background Esophageal rupture is an extremely rare condition to occur to a pregnant or postnatal woman. Esophageal ruptures have been previously described in the literature; however, they are most common in the setting of hyperemesis gravidarum. Case presentation This case report describes a 27-year-old white woman who began complaining of central chest pain and shortness of breath 3 hours after a normal vaginal delivery, with no history of vomiting antenatally or intrapartum. A chest X-ray and computed tomography pulmonary angiogram confirmed surgical emphysema and pneumomediastinum, and a diagnosis of esophageal rupture was made based on these findings. She was stable and conservative management was initiated; she improved over 4 days. Resolution of surgical emphysema was demonstrated on serial chest X-rays without requiring contrast swallow or surgical intervention. Conclusions This case exemplifies the importance of a timely diagnosis of esophageal rupture in ensuring a positive outcome for the patient. Delay in diagnosis can lead to an increase in morbidity and mortality.
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Affiliation(s)
- Stephanie Whelan
- Redlands Hospital, 54 Glen St, Kelvin Grove, QLD, 4059, Australia.
| | - Matthew Kelly
- Beaudesert Hospital, Beaudesert, Queensland, Australia
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Abstract
BACKGROUND In the United States, hyperemesis gravidarum is the most common cause of hospitalization during the first half of pregnancy and is second only to preterm labor for hospitalizations in pregnancy overall. In approximately 0.3-3% of pregnancies, hyperemesis gravidarum is prevalent and this percentage varies on account of different diagnostic criteria and ethnic variation in study populations. Despite extensive research in this field, the mechanism of the disease is largely unknown. Although cases of mortality are rare, hyperemesis gravidarum has been associated with both maternal and fetal morbidity. The current mainstay of treatment relies heavily on supportive measures until improvement of symptoms as part of the natural course of hyperemesis gravidarum, which occurs with progression of gestational age. However, studies have reported that severe, refractory disease manifestations have led to serious adverse outcomes and to termination of pregnancies. SUMMARY Despite extensive research in the field, the pathogenesis of hyperemesis gravidarum remains unknown. Recent literature points to a genetic predisposition in addition to previously studied factors such as infectious, psychiatric, and hormonal contributions. Maternal morbidity is common and includes psychological effects, financial burden, clinical complications from nutritional deficiencies, gastrointestinal trauma, and in rare cases, neurological damage. The effect of hyperemesis gravidarum on neonatal health is still debated in literature with conflicting results regarding outcomes of birth weight and prematurity. Available therapy options remain largely unchanged in the past several decades and focus on parenteral antiemetic medications, electrolyte repletion, and nutritional support. Most studies of therapeutic options do not consist of randomized control studies and cross-study analysis is difficult due to considerable variation of diagnostic criteria. Key Messages: Hyperemesis gravidarum carries a significant burden on maternal health and US health care. Most published research on pathogenesis is observational and suggests multifactorial associations with hyperemesis gravidarum. Precise, strictly defined criteria for clinical diagnosis are likely to benefit meta-analyses of further research studies regarding pathogenesis as well as therapeutic options.
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Affiliation(s)
- Viktoriya London
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Medical Center, Brooklyn, NY, USA
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Bustos M, Venkataramanan R, Caritis S. Nausea and vomiting of pregnancy - What's new? Auton Neurosci 2017; 202:62-72. [PMID: 27209471 PMCID: PMC5107351 DOI: 10.1016/j.autneu.2016.05.002] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 05/10/2016] [Accepted: 05/11/2016] [Indexed: 02/06/2023]
Abstract
Nausea and vomiting of pregnancy (NVP) is one of the most common disorders of pregnancy. The symptoms occur predominantly during the first trimester, although in a subgroup of patients they can continue throughout the entire pregnancy and can affect the woman's quality of life. A small percentage of women develop a severe form of NVP called hyperemesis gravidarum (HG) that if left untreated may lead to significant maternal morbidity and adverse birth outcomes. Overall, the morbidity in pregnant women with NVP is significant, although it tends to be underestimated. The pathogenesis of NVP remains unclear, but there is consensus that the disorder is multifactorial and that various genetic, endocrine and infectious factors may be involved. The treatment of NVP can be challenging as the optimal targets for therapy are not known. Currently, the therapy used depends on the severity of the disorder and it is focused on improving the symptoms while minimizing risks to mother and fetus. Therapies range from dietary changes, pharmacologic treatment or hospitalization with intravenous fluid replacement and nutrition therapy. The aims of this review are 1) to provide an overview of NVP, 2) to present possible links between the most important factors associated with the pathogenesis of NVP and 3) to discuss the effectiveness and safety of the pharmacologic and non-pharmacologic options available to treat this disorder.
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Affiliation(s)
- Martha Bustos
- School of Pharmacy, Department of Pharmaceutical Sciences, University of Pittsburgh, 716 Salk Hall, 3501 Terrace St, Pittsburgh, PA 15261, United States
| | - Raman Venkataramanan
- School of Pharmacy, Department of Pharmaceutical Sciences, University of Pittsburgh, 716 Salk Hall, 3501 Terrace St, Pittsburgh, PA 15261, United States; Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, United States
| | - Steve Caritis
- Department of Obstetrics, Gynecology and Reproductive Sciences Magee Womens Hospital, 300 Halket St., Pittsburgh, PA 15213-3180, United States; School of Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA 15213, United States.
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