scholarly journals Hamman’s syndrome: a case report of spontaneous pneumomediastinum after vaginal delivery

2020 ◽  
Vol 9 (4) ◽  
pp. 1735
Author(s):  
Marco Gentile ◽  
Mariaconcetta Zinna ◽  
Antonio Costanza ◽  
Andrea Remo ◽  
Giuseppe Sala ◽  
...  
Keyword(s):  
Rare Complication ◽  
Rare Condition ◽  
Medical Problem ◽  
Lateral View ◽  
X Ray ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Spontaneous Pneumomediastinum ◽  
Second Stage Of Labour ◽  
Chest X Ray

Spontaneous pneumediastinum (Hamman’s syndrome) is a rare pathology defined as the presence of free air in the mediastinum with subcutaneous emphysema without trauma or medical problem. It is also a rare complication of labour and delivery and it usually occurs in the second stage of labour. A twenty-six-year-old primigravida presented to our hospital at 39 weeks and 6 days in spontaneous labour. Two hours following the delivery the patient developed neck tightness and chest tenderness with palpation. Chest X-ray and CT scan revealed pneumomediastinum extending into the soft tissue of the neck. A conservative management was performed. Spontaneous pneumomediastinum is a rare condition with a reported incidence of less than 1:44000 and in the setting of pregnancy or labor 1:100000. Regarding pregnancy, the valsalva maneuvers produced in the second stage of labor has been implicated in the development of spontaneous pneumomediastinum. Chest X-ray (posteroanterior and lateral view) is the most important test to confirm the diagnosis. The Hamman’s syndrome has usually a benign course and the management in often conservative. A timely diagnosis of Hamman’s syndrome is necessary for patient safety and correct management, but most cases have a self-limiting course.

scholarly journals Spontaneous Pneumomediastinum in Labor

2017 ◽  
Vol 2017 ◽  
pp. 1-3 ◽  
Author(s):  
Mohamed Adnane Berdai ◽  
Said Benlamkadem ◽  
Smael Labib ◽  
Mustapha Harandou
Keyword(s):  
Subcutaneous Emphysema ◽  
Valsalva Maneuver ◽  
Rare Complication ◽  
Diagnostic Technique ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Spontaneous Pneumomediastinum ◽  
Major Interest ◽  
Chest X Ray ◽  
Limiting Condition

Spontaneous pneumomediastinum and subcutaneous emphysema also known as Hamman’s syndrome is a very rare complication of labor that is often related to the valsalva maneuver during the labor. In most case, Hamman’s syndrome is a self-limiting condition, rarely complicated unless there are underlying respiratory diseases. Chest X-ray can be a useful early diagnostic technique in severe clinical presentation. We report an uneventful pregnancy in a primigravid parturient, which was complicated in the late second stage of labor by the development of subcutaneous emphysema, pneumomediastinum, and mild pneumothorax. Spontaneous recovery occurred after four days of conservative management. This condition shows the major interest of labor analgesia especially locoregional techniques.

Cardiac instability due to Pneumomediastinum during second stage of labour

2009 ◽  
Vol 54 (2) ◽  
pp. 58-58
Author(s):  
J Rafi ◽  
H Muppala ◽  
B Schaefer
Keyword(s):  
Subcutaneous Emphysema ◽  
Case Reports ◽  
Neck Region ◽  
High Dependency Unit ◽  
X Ray ◽  
Second Stage ◽  
Cardiovascular Instability ◽  
Second Stage Of Labour ◽  
High Dependency ◽  
Chest X Ray

This case reports spontaneous pneumomediastinum in the second stage of labour leading to cardiovascular instability. Forceps were used to expedite delivery. Examination revealed characteristic crepitus of subcutaneous emphysema in the neck region, which was confirmed on chest X-Ray and CT scan. The patient was managed in the high dependency unit (HDU) for 48 hours and made a full recovery.

scholarly journals Spontaneous pneumomediastinum: experience in 18 patients during the last 12 years

2017 ◽  
Vol 43 (2) ◽  
pp. 101-105 ◽  
Author(s):  
Patrícia Dionísio ◽  
Luís Martins ◽  
Susana Moreira ◽  
Alda Manique ◽  
Rita Macedo ◽  
...  
Keyword(s):  
Chest Pain ◽  
Rare Condition ◽  
Tobacco Consumption ◽  
Sudden Increase ◽  
Precipitating Factors ◽  
Intense Exercise ◽  
Predisposing Factor ◽  
X Ray ◽  
Spontaneous Pneumomediastinum ◽  
Chest X Ray

ABSTRACT Objective: To characterize clinically all of the patients with spontaneous pneumomediastinum (SPM) admitted to an adult pulmonology ward in Lisbon, Portugal. Methods: This was a retrospective descriptive study of all adult patients (≥ 18 years of age) diagnosed with SPM between January of 2004 and September of 2015. Results: At least one predisposing factor was identified in most (88.9%) of the 18 patients who presented with SPM during the study period. With regard to precipitating factors, bouts of cough were present in 50.0% of the patients. Other precipitating factors included a sudden increase in tobacco consumption, inhaled drug use, occupational inhalation of varnish fumes, intense exercise, and vomiting. The most common complaints were dyspnea (in 83.3%) and chest pain (in 77.8%). Other complaints included cough, neck pain, dysphagia, and odynophagia. Subcutaneous emphysema was found in most of the patients. The diagnosis of SPM was based on chest X-ray findings in 61.1% of the patients. Conclusions: Although SPM is a rare condition, it should be considered in the differential diagnosis of chest pain and dyspnea. It can develop without a triggering event or conclusive findings on a chest X-ray, which is usually sufficient for diagnosis.

Spontaneous pneumomediastinum: A report of two cases at a District General Hospital

2021 ◽  
pp. 1753495X2110192
Author(s):  
Nathanael Yong ◽  
Oladimeji Olowu
Keyword(s):  
Chest Pain ◽  
Rare Condition ◽  
District General Hospital ◽  
Valsalva Manoeuvre ◽  
Second Stage ◽  
Spontaneous Pneumomediastinum ◽  
Management Algorithm ◽  
Second Stage Of Labour ◽  
Management Approaches ◽  
Limiting Condition

Spontaneous pneumomediastinum is a rare condition thought to be caused by excessive Valsalva manoeuvre during the second stage of labour. Women with pneumomediastinum typically presents with chest pain or tightness, dyspnoea, and a tearing sensation around the neck. It is commonly diagnosed with a chest radiograph but further imaging may be necessary to exclude more sinister conditions with similar clinical features. We describe two cases of pneumomediastinum and the different management approaches with different multi-disciplinary input. It is often a self-limiting condition. We propose a management algorithm for women suspected to have pneumomediastinum during the intrapartum and postpartum period.

scholarly journals An Unexpected Case of Intrapartum Pneumomediastinum

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Drishti Madhok ◽  
Vinayak Smith ◽  
Erik Gunderson
Keyword(s):  
Nitrous Oxide ◽  
Subcutaneous Emphysema ◽  
Valsalva Maneuver ◽  
Rare Complication ◽  
Healthy Woman ◽  
Second Stage ◽  
Spontaneous Pneumomediastinum ◽  
Second Stage Of Labour

The dyad of spontaneous pneumomediastinum and subcutaneous emphysema is collectively known as Hamman’s syndrome. This rare complication is known to occur during the intrapartum period and its aetiology has been linked to the Valsalva maneuver in the second stage of labour. Nitrous oxide inhalation increases the risk. We present the case of a 21-year-old healthy woman who experienced these symptoms after nitrous oxide inhalation during the second stage of labour.

scholarly journals Hamman’s syndrome: spontaneous pneumomediastinum and subcutaneous emphysema during second stage of labour

2017 ◽  
Vol 6 (6) ◽  
pp. 2622
Author(s):  
Ying Yiing Lou
Keyword(s):  
Subcutaneous Emphysema ◽  
Early Recognition ◽  
Rare Complication ◽  
Anterior Chest Wall ◽  
Second Stage ◽  
Second Stage Of Labour ◽  
Chest X Ray ◽  
Surgical Emphysema ◽  
Future Pregnancy ◽  
Limiting Condition

Subcutaneous emphysema with pneumomediastinum in labour is also known as Hamman's Syndrome. Maternal pneumomediastinum associated with subcutaneous emphysema is a rare complication of pregnancy. The incidence rate being between 1:2000 and 1:10,000. Pneumomediastinum occurs most frequently in the second stage of labour in a healthy primiparous women with prolonged labour. A 29-year-old primigravida, who had no relevant medical history, had an uneventful spontaneous vaginal delivery at term. She used Entonox as analgesia in labour. She developed facial and neck oedema associated with mild breathing discomfort towards the end of her second stage. Crepitus was felt in her cheek, neck and anterior chest wall. Observations were stable including oxygen saturation. Chest X-ray demonstrated gross and extensive surgical emphysema across the chest and up into the neck and with no evidence of pneumothorax. She was managed conservatively and the subcutaneous emphysema was found to have considerably better within 24 hours. She recovered uneventfully and was discharged within 3 days of admission. A future pregnancy is planned. Hamman’s syndrome is generally a self-limiting condition. The key to successful management is early recognition followed by appropriate measures to prevent further complications in order to reduce the morbidity and mortality associated with this condition. Supportive measures alone may be the only requirement for resolution. Recurrence of the condition is rare but the appropriate management of subsequent pregnancies is unclear. Our case was appropriately managed with multidisciplinary input in the HDU on labour ward.

Spontaneous Pneumomediastinum: Uncommon Cause of Air Leak in Late Preterm Neonate

2021 ◽  
Vol 35 (2) ◽  
pp. 93-94
Author(s):  
Jyotsna Bhushan ◽  
Shagufta Iqbal ◽  
Abhishek Chopra
Keyword(s):  
Respiratory Distress ◽  
Conservative Management ◽  
Preterm Neonate ◽  
Late Preterm ◽  
Intravenous Fluids ◽  
X Rays ◽  
Blood Gas ◽  
X Ray ◽  
Spontaneous Pneumomediastinum ◽  
Chest X Ray

A clinical case report of spontaneous pneumomediastinum in a late-preterm neonate, chest x-ray showing classical “spinnaker sail sign,” which was managed conservatively and had excellent prognosis on conservative management. Respiratory distress in a preterm neonate is a common clinical finding. Common causes include respiratory distress syndrome, transient tachypnea of the newborn, pneumonia, and pneumothorax. Pneumomediastinum is not very common cause of respiratory distress and more so spontaneous pneumomediastinum. We report here a preterm neonate with spontaneous pneumomediastinum who had excellent clinical recovery with conservative management. A male baby was delivered to G3P1A1 mother at 34 + 6 weeks through caesarean section done due to abruptio placenta. Apgar scores were 8 and 9. Maternal antenatal history was uneventful and there were no risk factors for early onset sepsis. Baby had respiratory distress soon after birth with Silverman score being 2/10. Baby was started on oxygen (O2) by nasal prongs through blender 0.5 l/min, FiO2 25%, and intravenous fluids. Blood gas done was normal. Possibility of transient tachypnea of newborn or mild hyaline membrane disease was kept. Respiratory distress increased at 20 h of life (Silverman score: 5), urgent chest x-ray done revealed “spinnaker sign” suggestive of pneumomediastinum, so baby was shifted to O2 by hood with FiO2 being 70%. Blood gas repeated was normal. Baby was managed conservatively on intravenous fluids and O2 by hood. Baby was gradually weaned off from O2 over next 5 days. As respiratory distress decreased, baby was started on orogastric feed, which baby tolerated well and then was switched to oral feeds. Serial x-rays showed resolution of pneumomediastinum. Baby was discharged on day 7 of life in stable condition on breast feeds and room air.

scholarly journals A dangerous pleural effusion

2010 ◽  
Vol 92 (5) ◽  
pp. e53-e54 ◽  
Author(s):  
Somprakas Basu ◽  
Shilpi Bhadani ◽  
Vijay K Shukla
Keyword(s):  
Rare Complication ◽  
Sudden Onset ◽  
Biliary Surgery ◽  
Biliary Leak ◽  
X Ray ◽  
Delay In Diagnosis ◽  
Aged Woman ◽  
Middle Aged Woman ◽  
Life Threatening ◽  
Chest X Ray

Bilothorax is a rare complication of biliary peritonitis and, if not treated promptly, can be life-threatening. We report a case of a middle-aged woman who had undergone a bilio-enteric bypass and subsequently a biliary leak developed, which finally led to intra-abdominal biliary collection and spontaneous bilothorax. The clinical course was rapid and mimicked venous thromboembolism, myocardial infarction and pulmonary oedema, which led to a delay in diagnosis and management and finally death. We high-light the fact that bilothorax, although a rare complication of biliary surgery, should always be considered as a probable cause of massive effusion and sudden-onset respiratory and cardiovascular collapse in the postoperative period. A chest X-ray and a diagnostic pleural tap can confirm the diagnosis. Once detected, an aggressive management should be instituted to prevent organ failure and death.

scholarly journals The Hanging Chin Sign As A Mortality Predictor In Geriatric Patients At The Emergency Department: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Anneloes NJ Huijgens ◽  
Laurens J van Baardewijk ◽  
Carolina JPW Keijsers
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Geriatric Patients ◽  
Lateral View ◽  
X Ray ◽  
Hospital Patients ◽  
Chest X Ray

Abstract BACKGROUND: At the emergency department, there is a need for an instrument which is quick and easy to use to identify geriatric patients with the highest risk of mortality. The so- called ‘hanging chin sign’, meaning that the mandibula is seen to project over one or more ribs on the chest X-ray, could be such an instrument. This study aims to investigate whether the hanging chin sign is a predictor of mortality in geriatric patients admitted through the emergency department. METHODS: We performed an observational retrospective cohort study in a Dutch teaching hospital. Patients of ≥ 65 years who were admitted to the geriatric ward following an emergency department visit were included. The primary outcome of this study was mortality. Secondary outcomes included the length of admission, discharge destination and the reliability compared to patient-related variables and the APOP screener.RESULTS: 396 patients were included in the analysis. Mean follow up was 300 days; 207 patients (52%) died during follow up. The hanging chin sign was present in 85 patients (21%). Patients with the hanging chin sign have a significantly higher mortality risk during admission (OR 2.94 (1.61 to 5.39), p < 0.001), within 30 days (OR 2.49 (1.44 to 4.31), p = 0.001), within 90 days (OR 2.16 (1.31 to 3.56), p = 0.002) and within end of follow up (OR 2.87 (1.70 to 4.84),p < 0.001). A chest X-ray without a PA view or lateral view was also associated with mortality. This technical detail of the chest x-ray and the hanging chin sign both showed a stronger association with mortality than patient-related variables or the APOP screener. CONCLUSIONS: The hanging chin sign and other details of the chest x-ray were strong predictors of mortality in geriatric patients presenting at the emergency department. Compared to other known predictors, they seem to do even better in predicting mortality.

scholarly journals Exploring caesarean delivery in the second stage of labour at a tertiary care hospital: a retrospective study

2021 ◽  
Vol 10 (10) ◽  
pp. 3929
Author(s):  
Pravinkumar A. Jadav ◽  
Palak M. Dabhi ◽  
Dhruti A. Rathod
Keyword(s):  
Retrospective Study ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Transfusion Rate ◽  
Care Hospital ◽  
Intraoperative Complication ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Second Stage Of Labour

Background: Caesarean section (CS) performed in the second stage of labour has many implications for maternal and neonatal morbidity as well as for subsequent pregnancies. The objectives of this study were to determine the rates of CS at full dilatation, their indications, associated maternal and neonatal complications.Methods: This retrospective study assessed all the women with a singleton fetus in cephalic presentation at term (≥37 weeks) who underwent CS in the second stage of labor between 1 August 2019 and 31 March 2020 at a tertiary care hospital. Maternal demographics, labour and delivery details as well as neonatal outcomes were collected.Results: During the study period, 2124 (36%) babies were born by CS. Of these, 49 (2.3%) were performed in the second stage of labour at ≥37 weeks of gestation. The most common indication of CS was non-descent of head in 38 (77.55%) of cases. The majority of women 38 (77.55%) delivered by CS in the second stage of labor were primiparous. The 27 (55.10%) women were in the age group of 20-25 years. Most common intraoperative complication was blood-stained urine in 20 (40.81%) women. Overall transfusion rate was 18.36%. Maximum number of babies born 44 (89.79%) were having birth weight between 2.5-3.5 kg. Out of 65 babies born, 17 (34.69%) were admitted to neonatal intensive care unit.Conclusions: Formulation of an institutional protocol and training and supervision of trainees to improve the skill of operative vaginal delivery and second stage cesarean is needed.

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