Hamman's Sign and Syndrome: A Reminder of Important Clinical Clues

Pneumomediastinum is an uncommon condition in pediatrics with a peak incidence in adolescence. The most common symptom of spontaneous pneumomediastinum (SPM) is chest pain; however, most patients are asymptomatic. Hamman's sign is a rare but pathognomonic sign of pneumomediastinum. This clinical sign is characterized by a crunching, rasping sound, synchronous with the heartbeat, heard over the precordium. Hamman's syndrome is a SPM associated with subcutaneous emphysema.

We report the case of a previously healthy 15-year-old adolescent male, an elite athlete, who was admitted to hospital with a 3-day history of chest pain. There was no history of previous respiratory infections, invasive procedures, or trauma. On physical examination, he had a palpable subcutaneous neck edema and a crackle on cardiac auscultation. Chest and neck radiographs confirmed ectopic air in the mediastinum and subcutaneous neck emphysema. Given the identification of Hamman's sign and the presence of emphysema, the diagnosis of Hamman's syndrome was made and symptomatic treatment was given with complete resolution.

This case highlights the value of physical examination and medical semiology in the diagnosis of Hamman's syndrome, especially in the presence of the pathognomonic Hamman's sign.