Presentation
4-day history of fever and violent cough, presented with neck swelling and crepitus.
Patient Data
Pneumomediastinum and extensive neck subcutaneous emphysema.
Left middle zone consolidation.
Left lingular consolidation with air bronchogram, in keeping with pneumonia.
Left upper lobe interstitial emphysema tracking to the hilum with pneumomediastinum and extensive subcutaneous emphysema involving the neck and upper chest wall, associated with cervical intraspinal extradural air (pneumorrhachis) and pneumoperitoneum locules.
Follow-up chest x-ray after 2 days shows interval improvement of the subcutaneous emphysema and pneumomediastinum, as well as clearing of the left upper lobe infiltrate.
Case Discussion
Rare pediatric case of Hamman syndrome, i.e. spontaneous pneumomediastinum and subcutaneous emphysema.
The patient presented with with a severe cough due to pneumonia, leading to spontaneous pulmonary interstitial emphysema via alveolar rupture. Air tracking to the hilum resulted in pneumomediastinum and extensive subcutaneous emphysema of the neck and upper chest wall, associated with pneumorrhachis and pneumoperitoneum.
Perforation and foreign body aspiration were ruled out.
The case was managed conservatively, with interval improvement on the follow-up x-rays.
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