Hamman’s Syndrome: a rare cause of rapidly progressive neck swelling and shortness of breath

Abstract

Spontaneous Pneumomediastinum, Hamman’s Syndrome, is a rare clinical condition characterized by existence of free air in the mediastinal cavity that is non-traumatic in nature. Predisposing risk factors include cocaine use, smoking, asthma, COPD and manoeuvres that raise intra-thoracic pressure such as vomiting, cough and physical exertion.

We present a challenging case of spontaneous pneumomediastinum in a young patient who presented with gradual onset of shortness of breath and right sided neck swelling, developing over 12 hours. He had no history of trauma, chest pain, vomiting or abdominal pain, however, mentioned a chronic non-productive cough that he attributed to long-term smoking. Patient had history of occasional cocaine and marijuana intake but denied any recent use. Clinical examination was unremarkable.

Laboratory investigations revealed neutrophilic leucocytosis (20.4x10^9/L), mildly elevated CRP (24mg/L) and normal serum amylase. Chest X-ray and CT Neck/Thorax revealed pneumomediastinum and surgical emphysema of right neck.

This case highlights the need for low index of suspicion for spontaneous pneumomediastinum in patients presenting with neck swelling and shortness of breath which is relevant to physicians in emergency department and acute medicine. Conservative approach is usually adopted for the management; however, antibiotics can be used where there is a suspicion of mediastinitis.