The “Born” conspiracy – swelling after spontaneous delivery

Introduction:

The spontaneous pneumomediastinum, also known as Hamman's disease, is a rare condition occurring in young, healthy males, but also in 1 of 20.000 – 100.000 delivering women.

Methods:

A 33 years old, healthy primigravida presented herself with a sore throat and cervical emphysema after spontaneous vaginal delivery. The ENT consultation found a subcutaneous supraclavicular emphysema as well as an endoscopically evident swelling in the naso- and oropharynx. Chest X-ray as well as CT-scan showed emphysema with involvement of the mediastinum without any signs for esophageal or tracheal rupture.

Results:

Because of stable cardio-pulmonary circulation further invasive diagnostic procedures such as tracheobronchoscopy or esophagoscopy were omitted. Under analgesia and rising nutritional intake the patient was discharged two days after presenting and clinical control examination on day 4 postpartum showed a restitutio ad integrum.

Conclusions:

Pneumomediastinum caused by spontaneous esophageal rupture is described as Boerhaave syndrome in pregnant women with hyperemesis gravidarum. Furthermore, an aggravation of intraalveolar pressure during Valsalva-maneuvers with consecutive laceration of the alveolar tissue is discussed as causal agent especially during labour. This can be accompanied by dyspnea and chest tightness. Invasive diagnostics may cause additional damage to the tissue but often remains without further consequences; therefore, it is not recommended, as well as prophylactic antibiotic treatment is not. The spontaneous regression of this rare and impressive disorder within a few days justifies a wait-and-watch strategy if life-threatening differential diagnoses, such as pulmonary embolism or organ perforation have been excluded.

Publication History

Publication Date:
12 June 2019 (online)