Neumomediastino espontáneo (síndrome de Hamman): Una enfermedad benigna mal diagnosticada

Abstract

Background:Hamman (Rev Méd Chile 2009; 137: 1045-50).

Pneumomediastinum and pneumopericardium in an adolescent with asthma attacks. Case report

“…(3) If the x-ray does not provide information, the chest CT will lead to the diagnosis, as it has been shown to be superior to x-ray in locating and measuring the extent; it is also important for differential diagnosis. (6,8) In this case, the disease was confirmed based on the images, which showed pneumopericardium, although no clinical sign had been reported.…”

“…It is more frequently observed in young patients without comorbidities, with the exception of asthma, and more than 75% of the cases occur in males with an average age of 20. (6) Two incidence peaks have been reported in the pediatric population: in children under seven years of age, probably secondary to lower respiratory tract infections, and in adolescents, due to asthma attacks and upper respiratory tract infections. (7) The increase in intrathoracic pressure is the main predisposing factor: the rupture of the alveoli, secondary to a difference in pressure gradients between the alveoli and the mediastinum, moves the air from the place with the highest pressure gradient (intra-alveolar space) to the mediastinal structures with the lowest pressure gradient.…”

“…In general, pneumomediastinum is benign and has good prognosis (1); its treatment is usually conservative, based on pain management, rest and bronchodilators. In addition, Valsalva maneuvers should be avoided and sometimes antibiotics and oxygen are necessary (6,10), reaching clinical resolution around the fourth day. (8) Pneumopericardium may resolve spontaneously, but in some cases pericardial drainage is necessary, especially with signs of tamponade.…”

Primary pneumomediastinum in a young woman with near fatal asthma. Diagnosis by ultrasound: a case report

“…On the other hand the predisposing factors are asthma, interstitial diseases, inhalation of some illicit drugs like cocaine, marijuana or other irritating substances. 2,4 Although the papers that report series of cases begin the diagnostic study with the simple chest x-ray, the gold standard of diagnosis continues to feel chest CT. [2][3][4] In our patient, the initial approach was performed with thoracic ultrasound. Tension pneumothorax was ruled out as a cause of decompensation and emphysema; observing the ultrasound findings compatible with pneumomediastinum, finally corroborated by chest CT.…”

“…1 The primary pneumomediastinum is a very rare entity; some series of cases report an incidence of 1: 7000 to 1: 45,000 admissions to emergency, predominantly in females; Although usually benign and self-limited, is often due to a patient's life-threatening condition. 2 We present the case of a young female patient who was admitted due to a severe asthmatic crisis that evolves unfavorably, in which the diagnosis of pneumomediastinum was performed by ultrasonography, ruling out the presence of pneumothorax.…”