Síndrome de Hamman: presentación de dolor torácico en un adolescente

Abstract

Resumen El dolor torácico en adolescentes es una causa de consulta frecuente en los servicios de urgencias; si el dolor es de inicio agudo, causa ansiedad y temor en los pacientes, que lo relacionan con una patología cardiovascular. Su amplia variedad de posibilidades diagnósticas constituye un desafío para el médico de urgencias que se enfrenta a este síntoma. Se presenta el caso de un adolescente de 15 años de edad previamente sano que comenzó con dolor precordial irradiado al cuello de inicio agudo y en quien se documentó un síndrome de Hamman como manifestación de un neumomediastino espontáneo. Hamman's syndrome as the cause of chest pain in an adolescentAbstract Chest pain in adolescents is a common cause of consultation in emergency services, if the pain is of acute onset it causes anxiety and fear in patients that relate it to a cardiovascular disease. Its wide variety of diagnostic possibilities poses a challenge for the emergency physician faced with this symptom. We present the case of a previously healthy 15 year old who debuted with chest pain of acute onset radiating to the neck. Hamman's syndrome was documented to have caused the symptoms.

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.…”

“…(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. (8) The dissection to release the free air is not only limited to the mediastinum, as this communicates with the mandibular space, the retropharyngeal space and the vascular beds within the neck. Once in the mediastinum, air can flow and cause pneumoperitoneum, pneumothorax and subcutaneous emphysema, although free air has also been found in the peritoneum, causing pneumoperitoneum.…”

“…(3) Confirmatory imaging findings include signet ring sign around the artery, double bronchial wall sign, continuous diaphragm sign, thymic sail sign, and subcutaneous emphysema. (3,8) The results of this test are usually normal in 10-30% of patients, especially in supine projection. (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.…”

Neumomediastino espontáneo idiopático. Primer caso pediátrico en Colombia

“…Neumomediastino es la presencia de aire en el espacio mediastínico, que puede ocurrir por cuerpos extraños, episodios eméticos, traumatismos, accesos de tos, otras maniobras de Valsalva, hiperventilación, procedimientos odontológicos con extracción dental, inmersiones, entre otras [1][2][3][4][5] . Es una enfermedad infrecuente, que se diagnostica en 1/1000 -44 000 ingresos hospitalarios en series internacionales 4,[6][7][8] .…”

“…Es una enfermedad infrecuente, que se diagnostica en 1/1000 -44 000 ingresos hospitalarios en series internacionales 4,[6][7][8] . No existen datos sobre frecuencia de presentación en Colombia, aunque hay un caso reportado por Morcillo y Vallejo (2015) en un adolescente de 15 años que practicaba motocross y ejercicio de carga pesada 2 . Otro caso colombiano, fue reportado por Estrada et al (2009) en una adolescente de 12 años que levantaba sacos de tierra 3 .…”