Hazem Amer
Hamad Medical Corporation, Qatar
Title: A rare case of spontaneous pneumomediastinum with dysmenorrhea Think fast and safe, Think PoCUS
Biography
Biography: Hazem Amer
Abstract
Background: Spontaneous pneumomediastinum (SPM) was reported in 1939 by Hamman, for whom the Hamman sign is named.
(SPM) is a rare condition with an incidence of less than 1:44,000 and is said to be more common in young males. Careful history
taking, physical examination, high index of suspicion and careful choice of radiological examination is needed to avoid missing the
diagnosis.
Case presentation: We report a 16 years old female presented to emergency department (ED) complaining of chest pain, vomiting
and abdominal pain related to dysmenorrhea. The patient was referred from a primary health center as case of chest pain for further
work up. Clinical diagnosis was missed after the initial chest x ray being reported by radiologist as normal. Another chest x-ray (CXR)
was obtained in ED after about 12 hours showing surgical emphysema and continuous diaphragm sign. CT chest with gastrographin
was done confirming the diagnosis showing no esophageal leak. The patient was admitted 4 days under conservative management
and was discharged asymptomatic with negative repeated x-ray.
Discussion: CXR reportedly misses or underestimates the severity of the SPM in 10–30% of cases. When CXR is equivocal but SPM
is clinically suspected, computed tomography is generally considered the diagnostic standard of choice. Since was first described
in 1983 as the (air gap sign), there is an expanding rule for Ultrasound in diagnosing SPM. We recommend use of Point of Care
Ultrasound (PoCUS) as an additional diagnostic tool in ED as it is safe, fast and radiation free.