Spontaneous Postpartum Pneumomediastinum (Hamman’s Syndrome): A Case Report and Review of Chest Pain Management in the Immediate Postpartum Period

TL;DR

A rare case of postpartum pneumomediastinum is reported, highlighting its symptoms, diagnosis, and conservative treatment in a woman after childbirth.

Contribution

This case report adds to the limited literature on spontaneous pneumomediastinum in the postpartum period and emphasizes its management.

Findings

A 25-year-old woman developed pneumomediastinum 24 hours after vaginal delivery, confirmed by CT scan.

Conservative treatment with analgesics, oxygen, and monitoring led to improvement within 24 hours.

An esophagogram ruled out esophageal tear, confirming the diagnosis of spontaneous pneumomediastinum.

Abstract

Spontaneous pneumomediastinum is a rare condition in the postpartum period, characterized by symptoms such as dyspnea, chest pain, subcutaneous neck edema, tachycardia, crepitus, dysphonia, and dysphagia. The Valsalva maneuver, commonly performed during the second stage of vaginal delivery, has been implicated as a key precipitating factor in the pathogenesis of this condition. We report the case of a 25-year-old woman (G1P1001, 39w5d), with a history of smoking, who developed postpartum dyspnea and chest pain 24 hours following an uncomplicated vaginal delivery. A comprehensive diagnostic workup, including a CT scan with intravenous contrast, confirmed severe pneumomediastinum. The patient was managed conservatively with analgesics, supplemental oxygen, and close clinical monitoring. A follow-up chest CT performed 24 hours later demonstrated interval improvement of the pneumomediastinum and an esophagogram excluded the presence of an esophageal tear or rupture. Although spontaneous pneumomediastinum is a rare obstetric complication of normal childbirth, it can present dramatically with chest pain, dyspnea, and hemodynamic instability. Diagnosis is established through a combination of history, clinical presentation, and radiographic findings. Management is conservative and includes analgesics, rest, supplemental oxygen therapy, and bronchodilators. Importantly, other potentially life-threatening causes of postpartum chest pain and dyspnea must be carefully ruled out to ensure timely and appropriate treatment.

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