An interesting case of post-partum chest tightness, facial asymmetry, and dysphonia.

Blackwell Publishing Netherlands 2020-04-29

Background: The aetiology of post-partum chest pain range from benign to life-threatening. Concerning causes include pulmonary embolism, pneumothorax, myocardial infarction, peripar-tum cardiomyopathy, aortic dissection, and oesophageal rupture. Case: A 24-year-old primigravid, antenatally well lady arrived fully dilated in spontaneous labour. She commenced pushing and at 1 h suddenly developed right-sided facial, eyelid, and neck swelling. She progressed to deliver a male liveborn baby. Day 1 post-partum she developed worsening throat swelling, dysphonia, chest tightness, and subcutaneous emphysema along her trachea and anterior chest with normal air entry and vital signs. An ECG was norma and chest x-ray showed pneumomediastinum and bilateral supraclavicular subcutaneous emphysema. A follow-up CT scan showed a moderate to large volume pneumomediastinum encircling the oesophagus, trachea, and thyroid. Gas was also tracking bilaterally within the bronchovascular interstitium, the oblique and right horizontal fissure, lower cervical soft tissues and bilateral supraclavicular regions with no signs of oesophageal perforation. She was diagnosed with Hamman's syndrome (spontaneous pneumomediastinum and subcutaneous emphysema) and managed conservatively. The patient's condition gradually stabilized prior to discharge. Discussion(s): Hamman's syndrome is an uncommon cause of spontaneous pneumomediastinum and subcutaneous emphysema. Pneumomediastinum occurs when air leaks through smal alveolar ruptures, the upper respiratory, or gastrointestinal tracts. Predisposing factors include prolonged labour, forceful coughing or vomiting, or asthmatic bronchospasm. Common presenting symptoms of pneumomediastinum include chest pain, dyspnoea, cough, neck pain, odynophagia, dysphagia. Exclusion of other serous causes of pneumomediastinum including pneumothorax and Boerhaave's syndrome (spontaneous transmural perforation of the oesophagus) is essential.

x-ray computed tomography; adult; aortic dissection; asthma; Boerhaave syndrome; bronchospasm; cardiomyopathy; chest tightness; conference abstract; controlled study; coughing; dysphonia; dyspnea; electrocardiogram; esophagus perforation; esophagus rupture; eyelid; face asymmetry; female; follow up; gastrointestinal tract; heart infarction; human; infant; interstitium; lung alveolus; lung embolism; male; neck pain; neck swelling; odynophagia; pneumomediastinum; pneumothorax; soft tissue; subcutaneous emphysema; thorax pain; thorax radiography; throat; trachea; vital sign; vomiting; young adult; Conference Abstract

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AUSHL oai:repository.monashhealth.org:1/36433
Australian and New Zealand Journal of Obstetrics and Gynaecology. Conference: Annual Scientifi c Meeting of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, RANZCOG 2019. Melbourne, VIC Australia. 59 (Supplement 1) (pp 76-77), 2019. Date of Publication: October 2019.
1479-828X
https://repository.monashhealth.org/monashhealthjspui/handle/1/36433
Monash Health
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(Chen) Monash Health
(Chen) Monash Health
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