Pneumomediastinum and Pericardium During Labour: A Report on a Rare Postpartum Phenomenon.

ABSTRACT

Hamman's syndrome (HS) is characterised by spontaneous pneumomediastinum and subcutaneous emphysema. It is a rare phenomenon that can occur during labour. Its incidence is 1 in 100,000 births and predominantly affects young primiparous women with prolonged labour. Patients commonly present with subcutaneous emphysema, chest pain, and dyspnoea. We present the case of a 20-year-old primigravida female with no other medical history who had prolonged labour at 43 weeks gestation. Sudden-onset, right-sided cheek pain and swelling was noted immediately after delivery accompanied by pleuritic chest pain. Chest X-ray (CXR) and computed tomography (CT) demonstrated significant pneumomediastinum and pneumopericardium with subcutaneous emphysema extending to the neck. She was managed symptomatically in addition to antibiotics and discharged after three days with complete resolution of symptoms. No concerns were raised during the follow-up. HS is a rare phenomenon that can occur during labour, particularly in young primiparous females with a prolonged second stage. Radiological investigations in the form of CXR and CT are recommended to rule out life-threatening complications and other conditions that may require immediate management. HS occurs due to rupture of peripheral alveoli secondary to increased intrathoracic pressures from excessive Valsalva manoeuvre allowing air to dissect and enter into the mediastinum. Pneumopericardium in association with HS is extremely rare. It is particularly clinically important because it can cause cardiac tamponade requiring immediate surgical management. HS is otherwise a self-limiting condition and management is symptomatic only. Our case is unique due to the presence of pneumopericardium in association with HS, the fourth ever reported in the literature. Due to its rarity, the incidence of tamponade in this cohort of patients is yet to be delineated.