Hamman-Macklin syndrome during labour associated with pneumothorax: a case report and a possible management

ABSTRACT
Background. We report a case of a primigravida who decided to undergo a Trial of Labor After Caesarean (TOLAC) and developed Hamman-Macklin syndrome, a rare medical condition characterized by the occurrence of spontaneous pneumomediastinum; in our case it was associated with pneumothorax, pneumopericardium in association with the presence of free air in the retroperitoneum. The patient was asymptomatic.

Case presentation. the pneumomediastinum was diagnosed the presence of free air with an X-ray scan and a CT, and it was ruled out the presence of an    injury in the respiratory tract with a laryngoscopy and a bronchoscopy. We suggest a standard clinical management, whose aim is to quickly diagnose the presence of free air and to consider rapidly the necessity of transfer to ICU setting. We suggest ruling out the presence of an organic lesion with diagnostic procedures such as laryngoscopy or bronchoscopy. This information can lead to different approaches in case of the necessity of invasive ventilation. The use of oxygen should be considered after performing a blood gas analysis while we suggest using antibiotics to prevent any infection.

Conclusions. It is desirable that the case reports be reported clearly and uniformly about this topic so that studies can be conducted with the aim of defining a standardized clinical approach to reach a consensus on the treatment of this pathology.  In this article we have proposed a case management of Hamman syndrome, further studies would be needed to confirm or refute our proposals.