Síndrome de Hamman em gestante: relato de caso / Hamman syndrome in pregnant women: case report

A síndrome de Hamman foi descrita pela primeira vez por Louis Hamman, em 1939, como "enfisema mediastinal espontâneo" e corresponde à presença de ar livre no mediastino, sem relação com trauma e/ou procedimentos invasivos na região torácica. A condição apresenta sintomas inespecíficos como dor torácica, dispneia, tosse, disfonia, disfagia e dor cervical. Devido aos sinais e sintomas inespecíficos, essa condição pode ser subdiagnosticada, contribuindo para a sua baixa incidência. O diagnóstico é estabelecido com exames de imagem como radiografia e tomografia computadorizada de tórax. No relato de caso descrito, temos uma paciente de 31 anos, gestante, G2P1A0, que desenvolve a síndrome concomitantemente a episódios de hiperêmese gravídica com cinco semanas e cinco dias de idade gestacional. O objetivo deste relato concentra-se em destacar essa hipótese diagnóstica para assistência adequada à paciente, uma vez que tal condição não faz parte do escopo cotidiano dentro da obstetrícia.(AU)

Hamman's syndrome was first described by Louis Hamman in 1939 as "spontaneous mediastinal emphysema" and is characterized by the presence of air in the mediastinum, unrelated to trauma, and/or invasive procedures in the thoracic region. The condition presents nonspecific symptoms such as thoracic pain, cervical pain, dyspnea, cough, and dysphonia. Due to the nonspecific signs and symptoms, this condition can be misdiagnosed, contributing to its low incidence. A diagnosis is established through imaging examinations such as chest radiography and computerized tomography. Here, we report the case of a 31-year-old female who developed Hamman's syndrome concomitantly with episodes of severe hyperemesis when she was five weeks and five days pregnant. Hamman's syndrome is a rare presentation in the field of obstetrics. This report seeks to highlight how Hamman's syndrome was diagnosed, discuss the care given to the patient, and explain the correlation between hyperemesis gravidarum and Hamman's syndrome.(AU)

Spontaneous Pneumomediastinum: A Rare Disease Associated with Chest Pain in Adolescents

PURPOSE: Spontaneous pneumomediastinum (SPM) is a rare entity, with only a few cases reported, especially in adolescents. We aimed to analyze the clinical characteristics of SPM in adolescents and the diagnostic implications of computed tomography (CT) and esophagography therein. MATERIALS AND METHODS: This retrospective descriptive study was conducted as a review of medical records of 416 adolescents (10-18 years of age) with chest pain from March 2005 to June 2013. Information on clinical presentation, methods of diagnosis, hospital stay, and outcomes were collected and analyzed. RESULTS: Among adolescents complaining of chest pain, 11 patients had SPM (11/416, 2.64%). All patients presented with pleuritic chest pain, and 54.5% reported neck pain as the most common associated complaint. Clinical findings were nonspecific, and initial chest X-ray assessment was diagnostic only in three of 11 patients. However, reassessment of chest X-ray revealed diagnostic findings of SPM in five of the remaining eight patients. CT was diagnostic in all patients, while esophagography and echocardiogram were uninformative. Symptomatic improvement was noted within 2.45+/-1.2 hours (range, 0.5 to 4) after supportive care; mean hospital stay was 4.54+/-0.99 days (range, 2 to 6). No recurrence was observed. CONCLUSION: SPM is a rare disease that should be considered in adolescent patients with pleuritic chest pain. Careful reading of initial chest X-rays is important to avoiding further unnecessary investigations. SPM is self-limited and treatment is supportive; nevertheless, if there are no indications of esophageal rupture, urgent esophagography is not recommended.

A rare case of ulcerative colitis with diffuse parenchymal lung disease, spontaneous pneumomediastinum and subcutaneous emphysema.

A 50-year-old male, a tobacco smoker, who was known to have ulcerative colitis presented with dry cough, chest pain, dysponea and frequent passage of blood and mucous mixed stools. Physical examination revealed clubbing, subcutaneous emphysema of upper chest and auscultatory findings of crunching sound over pre-cordial area and basal crepitations. Spirometry was suggestive of restrictive pattern. High resolution computed tomography (HRCT) of thorax revealed pneumomediastinum, subcutaneous emphysema, bilateral diffuse centrilobular nodules and ground-glass haziness with mosaic pattern along with posterior basal fibrotic changes. The present case documents the uncommon pulmonary involvement of spontaneous pneumomediastinum and subcutaneous emphysema diffuse parenchymal lung disease, in a patient with ulcerative colitis.

A Case of Conservatively Resolved Intramural Esophageal Dissection Combined with Pneumomediastinum / 대한소화기학회지

Intramural esophageal dissection (IED) is a rare form of esophageal injury. We report a rare case of spontaneous IED complicated with pneumomediastinum and successfully improved by conservative management. A 46-year-old man presented to the emergency department with chest pain and hematemesis. The endoscopic diagnosis was suspicious of IED. Chest CT scan performed to rule out complication noted IED combined with pneumomediastinum. He was managed conservatively with nil per oral, intravenous antibiotics and parenteral nutrition. Follow up study after 2 weeks later showed near complete resolution of IED. IED should be included in the differential diagnosis for unexplained acute chest pain, especially, associated with dysphagia and hematemesis. IED with pneumomediastinum or mediastinitis require prompt surgery. So far, there is no case report of IED combined with pneumomediastinum which resolved without surgical treatment. In this case, IED combined with pneumomediastinum has improved by conservative management, so we present a case report.

Pulmonary interstitial emphysema complicating pneumonia in an unventilated term infant.

A case of pulmonary interstitial emphysema with pneumothorax and pneumomediastinum complicating pneumonia in a 6-week-old infant is reported. The patient had no history of resuscitation, bag and mask ventilation, nasal continuous positive airway pressure or mechanical ventilation.

A case of spontaneous pneumomediastinum and pneumopericardium in a young adult

Spontaneous medialstinal emphysema (pneumomediastinum) and pneumopericardium may be defined as the presence of free air or gas in the mediastinal structures and in the pericardial sac without an apparent precipitating cause. It most frequently occurs in young healthy adults without serious underlying pulmonary disease. Although pneumomediastinum and pneumopericardium is often asymptomatic, it may cause pain in the neck and chest, dysphonia and shortness of breath. Treatment is supportive unless the patient has a history of trauma from foreign body aspiration. The course of spontaneous pneumomediastinum and pneumopericardium is usually benign and self-limited. A case of spontaneous pneumomediastinum, pneumopericardium and subcutaneous emphysema in a 20-year-old male is reported in this paper

Dermatomiosite complicada por doença pulmonar intersticial e pneumomediastino / Dermatomyositis complicated by interstitial lung disease and pneumomediastinum

Dermatomiosite (DM) é uma doença difusa do tecido conjuntivo caracterizada principalemtne por envolviemnto cutâneo e inflamação muscular. Em até 30 por cento dos casos pode haver acometimento pulmonar sob forma de doença intersticial. Pneumomediastino, pneumotórax e enfisema subcutâneo são complicações raramente descritas na literatura. Descreve-se caso de dermatomiosite juvenil e outro de dermatomiosite amiopática juvenil com doença pulmonar intersticial complicada por pneumodediastino com altas dose de corticosteróides. Os mecanismos etiopatogênicos de tais complicações ainda não estão bem claros, sugerindo-se vasculite em nível pulmonar ou rompimento de bolhas císticas secundárias a fibrose intersticial

Un caso de enfisema intramuscular tras cirugía toracoscópica valorado con radiología digital / Intramuscular emphysema after thoracoscopy: digital-Rx features

El enfisema intramuscular es una entidad poco frecuente, generalmente asociada a gangrena gaseosa, siendo muy rara su aparición como extensión de un neumomediastino. En el caso presentado por nosotros el enfisema intramuscular es secundario a neumotórax espontáneo asociado inicialmente a neumomediastino y enfisema subcutáneo, visualizado tras bullectomía toracoscópica. La difusión del aire desde un neumotórax al mediastino sólo se produce en el 1-2 por ciento de los casos. La radiología digital nos permite, entre otras posibilidades, ajustar la escala de grises, aplicar filtros de imagen dependiendo de la región anatómica a estudiar o realzar los bordes de la imagen antes de su impresión en placa

Neumomediastino secundario a un episodio de crisis moderada de asma bronquial / Pneumomediastine as a complication from the asthma crisis

El neumomediastino puede presentarse como una complicación de las crisis asmáticas hasta en el 5 por ciento de los casos; siendo más frecuente en niños pequeños que en adultos. Durante las crisis de asma, el aumento de la presión intraalveolar conduce a la ruptura de la unión alveolobronquiolar y el gas fugado diseca las vainas peribronquiovascular hasta llegar al mediastino drenado posteriormente hacia áreas de menor tensión tisular pudiendo comprimir las estructuras mediastinales conduciendo al trastorno del retorno venoso con riesgo de taponamiento cardiaco. Aunque generalmente la evolución satisfactoria caracteriza a este cuadro clínico, es importante tomar en cuenta que puede llegar a ser sumamente grave si se presenta el taponamiento cardiaco

Neumomediastino espontáneo en secuela de tuberculosis pulmonar / Spontaneous pneumomediastinum in pulmonary tuberculosis sequeale

Se presenta un caso de enfisema mediastínico y subcutáneo por secuelas de TBC crónica inactiva bilateral. Enfermo de 61 años que ingresa por tos intensa, disnea y dolor por enfisema subcutáneo de cuello y tórax. La Rx de tórax, revela secuelas fibrorretráctiles por antigua TBC pulmonar. Se trata con reposo, analgésicos y oxigenoterapia. Posteriormente se agrava con insuficiencia respiratoria y síndrome de vena cava superior. Con signo de Hamman (+) y radiología se hace diagnóstico de neumomediastino a tensión y sea efectúa mediastinotomía cervical, con mejoría dramática. Este tipo de neumomediastino se debió a ruptura de alvéolos o bronquíolos terminales a nivel de la cicatriz de tuberculosis previa. Por el aumento de la presión intrabrónquica el aire diseca el tejido peribronquial hasta mediastino. El signo de Hamman es un crujido que se escucha sincrónico con el sístole cardíaco y es patognomónico del neumomediastino. El neumomediastino generalmente es estabiliza y se recupera espontáneamente, pero cuando se hace hipertensivo, como en este caso, requiere la mediastinotomía y, el secundario a lesión de tráquea o bronquio requiere reparación quirúrgica inmediata. Este es el primer caso secundario a secuelas de TBC presentado

Neuropericardio y neumomediastino por inhalación de cocaina

Se presentan dos pacientes que consultaron a nuestra institución por dolor pericardial luego de gran consumo de de cocaína inhalada. En ambos casos se descartó infarto agudo de miocardio; por los métodos convencionales y ecocardiografía se documentó neumoparicardio y neumomediastino.

Multifocal atrial tachycardia: a complication of pneumomediastinum.

We report here an interesting case of multifocal atrial tachycardia (MAT) occurring as a complication of surgical emphysema with pneumomediastinum. The MAT reverted to sinus rhythm following aspiration of air from mediastinum.

Dermatomiosite juvenil de diagnóstico tardio com pneumotórax, pneumomediastino e enfisema subcutâneo espontâneos / Late diagnosis juvenile dermatomyositis with spontaneous pneumotorax, pneumomediastinum, and subcutaneous emphysema

Os autores descrevem caso de menina que aos 11 anos de idade apresentou quadro de escabiose eczematizada, acompanhada de artrite aguda aligoarticular remitente em um dia. Após 14 meses, desenvolveu quadro clássico de dermatomiosite juvenil, que cursou com pneumotórax, pneumomediastino e enfisema subcutâneo espontâneos, com acometimento infeccioso pulmonar conseqüente à terapêutica imunossupressora introduzida. Apesar do diagnóstico tardio, da rápida atividade da doença e das múltiplas intercorrências, o controle clínico-laboratorial foi conseguido, devido à corticoterapia e ao diagnóstico e tratamento precoces das complicaçöes

Pneumomediastino, enfisema subcutâneo e ar no espaço epidural como complicaçoës de cisto broncogênico / Pneumomediatinum, subcutaneous emphysema and air in the epidural space as complications of bronchogenic cyst

E apresentado um caso de cisto broncogênico que teve como complicaçäo a ocorrência de pneumomediastino, enfisema subcutêneo e ar no espaço epidural

Pneumomediastino secundario a perfuraçao de diverticulo colico / Pneumomediastinum due to colonic perfuration of colonic deverticulum

Os autores apresentam um caso incomum de pneumomediastino secundario a perfuraçao de diverticulo colico. Chamam a atençao para a pobreza de sintomas abdominais, mostram acompanhamento radiologico ate a resoluçao e analisam uma ampla pesquisa bibliografica da literatura mundial dos ultimos vinteanos para casos semelhantes.