Hamman’s crunch: a forgotten clue to the diagnosis of spontaneous pneumomediastinum

Alexandre, André; Marto, Natália; Raimundo, Pedro

doi:10.1136/bcr-2018-225099

Cited by 6 publications

(5 citation statements)

References 2 publications

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“… 9 , 14–16 In 2018, a case report of a patient with pneumomediastinum included a recording of Hamman’s sign heard by auscultation with a stethoscope. 5 In 2019, another case of Hamman’s sign, secondary to a left-sided pneumothorax, was recorded at the emergency department. The audible clicks did not seem to be in relation to the heartbeats.…”

Section: Discussionmentioning

confidence: 99%

“… 4 Despite its value in the differential diagnosis of left-sided pneumothorax, pneumomediastinum, and valvular pathology such as mitral valve prolapse, the sound itself has only rarely been recorded. 5 , 6 This case report can make this sound accessible to physicians taking care of patients presenting with audible clicks in association with dyspnoea and/or thoracic pain.…”

Section: Introductionmentioning

confidence: 91%

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The clicking chest: what exactly did Hamman hear? A case report of a left-sided pneumothorax

Jimidar

Lauwers

Govaerts³

et al. 2020

European Heart Journal - Case Reports

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Background Hamman’s sign is a rare phenomenon. Louis Hamman described this pathognomonic clicking chest noise in association with pneumomediastinum in 1937. This typical noise can also be present in left-sided pneumothorax. Clinical cases already mention this pericardial knock in 1918 in gunshot wounds of the left chest and in 1928 in cases of spontaneous left-sided pneumothorax. However, the sound itself has only rarely been recorded. Case summary We describe a case of a young man with no significant medical history who was referred to the hospital with chest pain and audible clicks, documented with his smartphone. Imaging studies including chest radiograph and computed tomography scan revealed a left-sided pneumothorax. The patient underwent semi-urgent insertion of a thorax drain. His clinical outcome was excellent. Discussion In recent years only a few case reports describe Hamman’s sign, as it is rare and happens only transiently. This case report includes the audible clicks recorded by the patient with his smartphone. We stress the importance of thoracic clicking sounds as key symptom in the differential diagnosis of left-sided pneumothorax, pneumomediastinum, and valvular pathology such as mitral valve prolapse.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 91%

The clicking chest: what exactly did Hamman hear? A case report of a left-sided pneumothorax

Jimidar

Lauwers

Govaerts³

et al. 2020

European Heart Journal - Case Reports

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“…A notable physical exam finding in pneumomediastinum is the Hamman’s sign. Hamman’s sign, also known as Hamman’s crunch, is the presence of a “crunch” synchronous with the heart beat on cardiac auscultation ( 24 ). Subcutaneous emphysema (70%) may be present as well ( 10 , 12 ).…”

Section: Overview Of Pneumomediastinummentioning

confidence: 99%

A clinical review of spontaneous pneumomediastinum

Susai,

Banks,

Alcasid

et al. 2024

Mediastinum

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Primary spontaneous pneumomediastinum is a rare, often benign and self-limited condition defined by air within the mediastinum. However, correctly distinguishing primary spontaneous pneumomediastinum from secondary causes, especially esophageal perforation, remains a diagnostic challenge. There is significant debate regarding the balance of completing a thorough but not overly invasive and costly diagnostic workup. This clinical review aims to gather the limited data regarding spontaneous pneumomediastinum management from case series and retrospective cohort studies, and presents an evaluation algorithm and treatment plan stratified by clinical history. Understanding specifically if the patient presents with coughing versus forceful vomiting is critical to help elucidate the etiology and guide management of pneumomediastinum. Patients who present with forceful vomiting or retching should be considered with higher degree of suspicion for secondary causes of pneumomediastinum, specifically esophageal perforation. However, especially in children, aggressive diagnostic workup is not warranted in every case. After ruling out other etiologies of pneumomediastinum, spontaneous pneumomediastinum can be commonly treated with symptomatic management without the aggressive use of antibiotics or diet restriction. Hospital length of stay may also be minimized on a case-by-case basis. Overall, recurrence of spontaneous pneumomediastinum is rare and outpatient follow up may be safely limited to those at highest risk of recurrence.

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“…This condition is usually seen in young males who experience an acute onset of chest pain, dyspnea, odynophagia, and/or voice changes [2,4]. Physical examination frequently reveals subcutaneous emphysema, hoarse voice, tachycardia, tachypnea, and occasionally a "Hamman's sign," which is a crunching sound heard on cardiac auscultation [1][2][3][4][5]. While patients with SPM typically fare well, the initial investigation should be extensive in order to rule out serious conditions such as esophageal rupture, i.e., Boerhaave syndrome, ruptured viscus, or blunt trauma [2].…”

Section: Introductionmentioning

confidence: 99%

A Case Report of Spontaneous Pneumomediastinum From an Unusual Cause: Baritone Practice

Meloy,

Bhambri,

Emeli

2023

Cureus

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Spontaneous pneumomediastinum (SPM) is a rare but potentially life-threatening clinical entity in which free air is introduced into the mediastinum. It most commonly presents in young males and has an incidence of approximately 0.002% of the general population. Symptoms include sudden onset chest pain, dyspnea, neck pain, vomiting, and odynophagia. Physical examination usually reveals subcutaneous emphysema, hoarse voice, tachycardia, tachypnea, and occasionally a Hamman's sign, which is a mediastinal "crunch" sound heard on cardiac auscultation. We present a case of an 18-year-old male baritone player who presented to the ED with chest pain and odynophagia shortly after waking up one morning. The patient's chest radiograph (CXR) revealed free air in the mediastinum with subcutaneous air tracking into the soft tissues of the neck and supraclavicular region. CT of the chest with contrast esophagram confirmed the diagnosis of primary SPM. The cause of his condition was likely due to barotrauma secondary to playing the baritone in his marching band. He had no evidence of esophageal injury or infectious process which further supports the diagnosis of primary SPM. After an extensive workup, the patient was discharged from the ED with instructions on rest, analgesia, and antitussives as needed. Evaluation of chest pain patients in the ED should include a CXR, in addition to other indicated tests, to rule out this potentially debilitating condition. Fortunately, though SPM is potentially life-threatening, most cases resolve spontaneously without surgical intervention.

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Hamman’s crunch: a forgotten clue to the diagnosis of spontaneous pneumomediastinum

Cited by 6 publications

References 2 publications

The clicking chest: what exactly did Hamman hear? A case report of a left-sided pneumothorax

The clicking chest: what exactly did Hamman hear? A case report of a left-sided pneumothorax

A clinical review of spontaneous pneumomediastinum

A Case Report of Spontaneous Pneumomediastinum From an Unusual Cause: Baritone Practice

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