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Hamman's Syndrome

 

 

Related narrative: Hamman's Syndrome

Spontaneous pneumomediastinum (Hamman's syndrome) results from barotrauma causing intraparenchymal rupture of alveoli or small bronchi. The air can dissect along bronchi and vessels and spread in the mediastinum, pericardium, neck, subcutaneous tissue and retroperitoneum. The air may also enter the pleural space causing pneumothorax. The pressure of the interstitial air rarely causes respiratory compromise, but may cause some degree of pain.

The inciting cause is usually exacerbation of bronchospastic pulmonary disease with sudden forceful valsalva maneuver against the closed glottis. The syndrome is also associated with inhalational drug use (free base cocaine, marijuana) in which the user performs forceful valsalva to enhance the drug effect. Blunt trauma may also cause interstitial air dissection.

Serious alternative causes of the free air must be ruled out. Esophageal rupture with forceful emesis (Boerhaave's syndrome) or from trauma (blunt trauma, instrumentation) is evaluated with water soluble contrast (gastrografin) esophagogram and chest CT. Only about 60% of patients with esophageal injury will manifest subcutaneous emphysema. However, lower mediastinal air should raise the index of suspicion for esophageal rupture. Such patients' earliest symptom is tachycardia from mediastinal irritation, and they tend to go into sudden septic shock with progression of an untreated perforation. Suspicion of major bronchial injury should be investigated with bronchoscopy.

References:

Rosen: Emergency Medicine: Concepts and Clinical Practice, 4th ed., Copyright 1998 Mosby-Year Book, Inc. :548, 1514.

Sabiston: Textbook of Surgery, 15th ed., Copyright 1997 W. B. Saunders Company :1907.

Spontaneous pneumomediastinum.
Tytherleigh MG - J Accid Emerg Med - 1997 Sep; 14(5): 333-4.


This page was last modified on 8-Jan-2001.