Spontaneous Pneumomediastinum and Subcutaneous Emphysema: A Rare Case Report Following Vaginal Delivery

Öz

Spontaneous pneumomediastinum (SPM) is a rare clinical condition characterized by the presence of free air in the mediastinum. It is infrequently encountered during pregnancy and childbirth and usually follows a benign course. This report presents the case of a 29-year-old primigravida woman who developed pneumomediastinum and subcutaneous emphysema after vaginal delivery, manifesting with chest pain and dyspnea. The patient had a body mass index at the threshold of obesity, and repetitive Valsalva maneuvers during labor were considered contributory. Conservative treatment was initiated, including catheter drainage of subcutaneous emphysema and empirical antibiotic therapy. Clinical symptoms resolved completely within five days, and radiological improvement was achieved within one week.

Anahtar Kelimeler

• Spontaneous pneumomediastinum
• Hamman syndrome
• vaginal delivery
• subcutaneous emphysema
• Valsalva maneuver

Spontan Pnömomediastinum ve Subkutanöz Amfizem: Vajinal Doğum Sonrası Gelişen Nadir Bir Olgu Sunumu

Öz

Spontan pnömomediastinum (SPM), mediastende serbest hava varlığı ile karakterize nadir bir klinik tablodur. Gebelik ve doğum sırasında nadiren görülür ve genellikle benign bir seyir izler. Bu yazıda, vajinal doğum sonrası göğüs ağrısı ve dispne ile başvuran 29 yaşında primigravid bir kadında gelişen pnömomediastinum ve subkutanöz amfizem olgusu sunulmuştur. Hastanın beden kitle indeksi obezite sınırındaydı ve doğum sırasında tekrarlayan Valsalva manevralarının duruma katkıda bulunduğu düşünüldü. Subkutanöz amfizeme yönelik kateter drenajı ve ampirik antibiyotik tedavisi dâhil olmak üzere konservatif tedavi başlatıldı. Klinik semptomlar beş gün içinde tamamen düzeldi ve radyolojik iyileşme bir hafta içinde sağlandı.

Anahtar Kelimeler

• Spontan pnömomediastinum
• Hamman sendromu
• vajinal doğum
• subkutanöz amfizem
• Valsalva manevrası

Kaynakça

1. 1. La Verde M, Palmisano A, Iavarone I, et al. A Rare Complication during Vaginal Delivery, Hamman's Syndrome: A Case Report and Systematic Review of Case Reports. Int J Environ Res Public Health. 2022;19(8):4618.
2. 2. Kouki S, Fares AA. Postpartum spontaneous pneumomediastinum 'Hamman's syndrome'. BMJ Case Rep. 2013;2013:bcr2013010354.
3. 3. Kandiah S, Iswariah H, Elgey S. Postpartum pneumomediastinum and subcutaneous emphysema: two case reports. Case Rep Obstet Gynecol. 2013;2013:735154.
4. 4. Badran D, Ismail S, Ashcroft J. Pneumomediastinum following spontaneous vaginal delivery: report of a rare phenomenon. J Surg Case Rep. 2020;2020(6):rjaa076.
5. 5. Inesse AA, Ilaria R, Camille O. Protracted Labor Complicated by Pneumomediastinum and Subcutaneous Emphysema: A Rare Case Report and Management Considerations. Am J Case Rep. 2023;24:e940989.
6. 6. McGregor A, Ogwu C, Uppal T, Wong MG. Spontaneous subcutaneous emphysema and neumomediastinum during second stage of labour. BMJ Case Rep. 2011;2011:bcr0420114067.
7. 7. Khoo J, Mahanta VR. Spontaneous pneumomediastinum with severe subcutaneous emphysema secondary to prolonged labor during normal vaginal delivery. Radiol Case Rep. 2015;7(3):713.
8. 8. Çelik B, Pirzirenli MG, Bilgin Büyükkarabacak Y, et al. Clinical and radiological characteristics of patients treated with the diagnosis of spontaneous pneumomediastinum. Curr Thorac Surg. 2021;6(1):1-6.

9. 9. Kuruba N, Hla TT. Postpartum spontaneous pneumomediastinum and subcutaneous emphysema: Hamman's syndrome. Obstet Med. 2011;4(3):127-128.
10. 10. Berdai MA, Benlamkadem S, Labib S, Harandou M. Spontaneous Pneumomediastinum in Labor. Case Rep Obstet Gynecol. 2017;2017:6235076.
11. 11. Aljohani A, Alsufiani H, Ahmed G. Non-invasive management of severe subcutaneous emphysema in a pediatric asthma exacerbation: a case report and review. Int J Emerg Med. 2024;17:203.
12. 12. Alyassin N, Rajab I, Higgins S, Pelidis M, Lamm R. Radiographic Convergence: A Case of Pneumomediastinum, Pneumothorax, Pneumopericardium, and Subcutaneous Emphysema. J Investig Med High Impact Case Rep. 2025;13:23247096251367550.
13. 13. Edwards M, Ramappa A. An Uncommon Cause of Spontaneous Pneumomediastinum and Subcutaneous Emphysema. EJCRIM. 2017;4(4).
14. 14.Jakes AD, Kunde K, Banerjee A. Case report: Postpartum pneumomediastinum and subcutaneous emphysema. Obstet Med. 2019;12(3):143-5.