Spontaneous pneumomediastinum (Hamman's syndrome)☆
Introduction
Spontaneous pneumomediastinum is defined as the presence of mediastinal free air in the absence of an obvious precipitating cause. The first case series of spontaneous pneumomediastinum was published by Louis Hamman in 1939 and therefore the condition is called Hamman's syndrome.1 The pathophysiological process was experimentally demonstrated by Macklin and Macklin in 1944.2 Barotrauma causes alveolar rupture which then allows air to flow down a pressure gradient from the alveolus to the mediastinum via the pulmonary interstitium and pulmonary hilum (The Macklin effect). Spontaneous pneumomediastinum is usually a benign self-limiting illness affecting young males. However, it is a condition that is not widely recognised by clinicians. The aim of this paper is to review our experience, discuss mechanisms and provide a new management algorithm.
Section snippets
Methods
A retrospective case note review of patients with spontaneous pneumomediastinum was performed over a five-year period from April 2003 to April 2008. All surgical patient's clinical details are recorded using the Lothian Surgical Audit System (LSAS). The LSAS and ICD (International standard classification of disease and related health problems) version 10 database from the hospital information system were both examined retrospectively to identify patients. The patients were treated at the Royal
Results
A total of 17 patients were identified with spontaneous pneumomediastinum. The male to female ratio was 14:3. The median age of presentation was 19 years with a range of 12–35 years.
Predisposing factors to spontaneous pneumomediastinum occurred in 10 out of the 17 patients (Table 1). The most common factor was ethanol intoxification seen in four patients. Of the potential precipitating causes of lung alveolar rupture, vomiting and coughing were the most common factors in nine patients. Only
Discussion
Our study shows that spontaneous pneumomediastinum occurs predominantly in young males in agreement with many other case series.3, 4 Our incidence of one per 32,000 hospital accident and emergency admissions also compares well to the reported incidence in the literature, which ranges from one in 8005 to one in 42,000.4
Pneumomediastinum can be produced by three different mechanisms: 1) Disruption of a cutaneous or mucosal barrier (usually the tracheobronchial tree or the oesophagus) which allows
Conclusion
Spontaneous pneumomediastinum is an uncommon condition that predominantly affects young males. It occurs because of a rupture to an alveolus, usually due to vomiting or coughing. Making an accurate early diagnosis of spontaneous pneumomediastinum is important because the presentation can be similar to Boerrhaave's syndrome. All patients should therefore be investigated with a radiographic contrast swallow examination to exclude a perforation to the oesophagus. Patients can then be discharged
References (8)
Spontaneous pneumomediastinum
Am J Surg
(1976)- et al.
Assessment of spontaneous pneumomediastinum: experience with 12 patients
Ann Thorac Surg
(2003) Spontaneous mediastinal emphysema
Bull Johns Hopkins Hosp
(1939)- et al.
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
Medicine
(1944)
Cited by (44)
Spontaneous Pneumomediastinum: Rare Complication of Tracheomalacia
2020, Archivos de BronconeumologiaTwo cases of spontaneous pneumomediastinum with pneumothorax in patients with COVID-19 associated pneumonia
2020, Respiratory Medicine Case ReportsSpontaneous Pneumomediastinum and Subcutaneous Emphysema: Hamman's Syndrome
2019, Archivos de BronconeumologiaPostmortem imaging identified pneumomediastinum in two cases of diabetic ketoacidosis
2017, Journal of Forensic Radiology and ImagingCitation Excerpt :The pathophysiological mechanism of pneumomediastinum is advocated to be barotrauma by Macklin et al. [12]. Increased intrathoracic pressure causes the alveolar rupture, which results in air leakage from the alveolus to the mediastinum via the pulmonary interstitium and pulmonary hilum [4,11]. DKA is an acute and serious metabolic complication, usually of type I diabetes mellitus, but occasionally of type II.
An unusual case of abdominal pain: psychogenic vomiting complicated by spontaneous pneumomediastinum
2023, BMC Pulmonary Medicine
- ☆
No financial support was used in the preparation of this article.