Pneumomediastinum as a cause of acute chest pain postpartum

Abstract

Pneumomediastinum can easily be mistaken for a pulmonary embolus or myocardial infarction. We describe herein a case of pneumomediastinum postpartum. A primigravida complained five-hours postpartum of acute chest pain and mild dyspnea. The initial (working) diagnosis was pulmonary embolus and the patient was treated with antithrombotic therapy. A CT scan revealed the real cause of the chest pain: pneumomediastinum. The patient was given adequate analgesia and two days later was able to leave the hospital in good clinical condition. We suggest that in the case of acute chest pain during or shortly following labor, pneumomediastinum should be considered.

Hamman and Boerhaave syndromes – diagnostic dilemmas in a patient presenting with hyperemesis gravidarum: a case report

“…6 The commonest sites for clinically evident subcutaneous emphysema are the upper anterior thoracic wall as well as the anterior and lateral aspects of the neck though some cases have been reported of emphysema in the upper abdomen and occasionally as superior as the lateral aspect of the face and orbit. 2 Patients with HS tend to present with dysphonia, chest pain, dyspnoea and palpitations.…”

“…It is thought that air from damaged or ruptured alveoli is expelled and travels by way of sheaths encompassing small blood vessels to the mediastinum from which it then tracks superficially to the subcutaneous tissues. 6 The commonest sites for clinically evident subcutaneous emphysema are the upper anterior thoracic wall as well as the anterior and lateral aspects of the neck though some cases have been reported of emphysema in the upper abdomen and occasionally as superior as the lateral aspect of the face and orbit. 2…”

Spontaneous subcutaneous emphysema and pneumomediastinum during second stage of labour

“…Air, under pressure, leaks into the perivascular connective tissue planes and then into the mediastinum, retropharyngeal and subcutaneous spaces of the neck;7 from here air can track throughout the body. The clinical presentation depends on the amount of air in the free spaces, and often involves chest pain, breathlessness and facial swelling.…”

“…The clinical presentation depends on the amount of air in the free spaces, and often involves chest pain, breathlessness and facial swelling. The typical Hamman’s sign of ‘crackles or churning sounds heard in the lateral decubitus position during systole’7 is commonly missed or not looked for because of lack of awareness by clinicians. Indeed, in this case, Hamman’s sign was not elicited because of unfamiliarity.…”

Cardiac instability due to Pneumomediastinum during second stage of labour

“…We considered pulmonary embolism and myocardial infarction in the initial workup but did not initiate antithrombotic treatment. 4 This was because our patient did not have respiratory symptoms, her oxygen saturations were maintained within the normal range and her chest pain improved over 30 minutes before her vitals deteriorated.…”