Hamman's syndrome is characterized by the sudden occurrence of spontaneous pneumomediastinum related to high intensity physical exercise, severe cough, or drug inhalation.(1)

With an incidence of about 1 per 30,000 emergency patients,(2) Hamman's syndrome mainly affects males in the second decade of life, several of whom having asthma. The most common signs and symptoms are sudden chest pain and dyspnea, followed by stridor, dysphagia, or dysphonia.(3)

A 25-year-old male, former smoker, had an episode of intense cough during a football match, developing sudden oppressive intense precordial chest pain, dyspnea, dysphonia, and odynophagia. No history of trauma, surgery/other invasive procedures, drug inhalation, or vomiting was reported. Admitted to the ER, the patient showed an exuberant cervical swelling and crackles during palpation. CT scanning showed massive pneumomediastinum and cervical subcutaneous emphysema (Figure 1). After exhaustive investigation, we found that the abrupt increase in intrathoracic pressure was the consequence of an episode of forceful cough during an intense physical activity, characterizing Hamman's syndrome. Spontaneous pneumomediastinum was totally resolved without the use of invasive procedures.
 



We intend to alert that Hamman's syndrome should be included in the differential diagnosis of young patients with sudden cervicothoracic complaints, because it is potentially fatal if it is not rapidly diagnosed.

REFERENCES

1. Dionísio P, Martins L, Moreira S, Manique A, Macedo R, Caeiro F, et al. Spontaneous pneumomediastinum: experience in 18 patients during the last 12 years. J Bras Pneumol. 2017;43(2):101-105. https://doi.org/10.1590/s1806-37562016000000052
2. Song IH, Lee SY, Lee SJ, Choy WS. Diagnosis and treatment of spontaneous pneumomediastinum: experience at a single institution for 10 years. Gen Thorac Cardiovasc Surg. 2017;65(5):280-284. https://doi.org/10.1007/s11748-017-0755-3
3. Dajer-Fadel WL, Argüero-Sánchez R, Ibarra-Pérez C, Navarro-Reynoso FP. Systematic review of spontaneous pneumomediastinum: a survey of 22 years' data. Asian Cardi-ovasc Thorac Ann. 2014;22(8):997-1002. https://doi.org/10.1177/0218492313504091