Elsevier

The Surgeon

Volume 8, Issue 2, April 2010, Pages 63-66
The Surgeon

Spontaneous pneumomediastinum (Hamman's syndrome)

https://doi.org/10.1016/j.surge.2009.10.007Get rights and content

Abstract

Introduction

Spontaneous pneumomediastinum is defined as the presence of free air in the mediastium in the absence of any obvious precipitating cause. The purpose of this study was to review our experience with this condition, discuss mechanisms and provide a management algorithm.

Methods

A retrospective audit of patients admitted with spontaneous pneumomediastinum between 2003 and 2008 was performed. A total of 17 patients were identified.

Results

Common predisposing factors for spontaneous pneumomediastinum were alcohol excess, asthma and illicit drug use. Vomiting and coughing were common precipitating factors. There was no morbidity, mortality or recurrence. Patients were admitted under a number of different specialties.

Discussion

Spontaneous pneumomediastinum is a benign self-limiting condition that requires early differentiation from more serious causes, in particular Boerhaave'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)

There are more references available in the full text version of this article.

Cited by (44)

  • Postmortem imaging identified pneumomediastinum in two cases of diabetic ketoacidosis

    2017, Journal of Forensic Radiology and Imaging
    Citation 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.

View all citing articles on Scopus

No financial support was used in the preparation of this article.

View full text