Hamman's sign in a teenager with spontaneous pneumomediastin
The present case has been reported in the Journal of Pediatrics. A previously healthy, 14-year-old boy presented with chest pain lasting 1 day. He had no complaints of fever, cough, dyspnea, nausea, or vomiting nor did he have any history of asthma or trauma.

Upon physical examination, a crackling sound synchronous with heartbeat, the so-called Hamman's sign, was noted on cardiac auscultation in the lower left sternal border. Lung auscultation was clear, and no heart murmur was present. No apparent subcutaneous emphysema was found.

The chest radiograph showed multiple linear air leaks along the trachea and subcutaneous emphysema in the right shoulder. The characteristic auscultations, radiographic findings, and the absence of signs of other triggers including asthma, trauma, and infection led us to diagnose spontaneous pneumomediastinum. The patient recovered within 1 week.

Learning Points:-
• Spontaneous pneumomediastinum in children is uncommon, and the diagnosis is challenging for pediatricians and emergency department physicians.

• Although chest radiograph and computed tomography are useful, this case highlights the importance of auscultation for suspected spontaneous pneumomediastinum.

• This characteristic sound has been described variously as rasping, crunching, bubbling, crepitant, crackling, clicking, or popping1 and is thought to occur as a result of the compression of air-filled mediastinal tissue between the heart and anterior chest wall.

• Recognizing these findings is helpful for diagnosing spontaneous pneumomediastinum and may help avoiding unnecessary tests.

Source: https://pxmd.co/TlkqQ
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