Highly alert mom: recognizing hamman’s sign in children and its importance in early detection of a pneumothorax

CASE REPORTS

Highly alert mom: recognizing Hamman’s sign in children and its importance in early detection of a pneumothorax

André Morais¹, Inês Candeias¹, Carla Garcez², Arnaldo Cerqueira².

¹Pediatrics Department, Hospital de Braga, Portugal,
²Intermediate Pediatric Care Unit, Hospital de Braga, Portugal.

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Abstract
A 7-year-old boy was brought to a pediatric appointment by his mother due to an abnormal sound coming from his son's chest, that she heard while he was sleeping, loud enough to wake her up. A left-sided pneumothorax was diagnosed. The boy was referred to the emergency department and then promptly treated. One month later, his mother noticed the return of the sound and suspected a relapse, bringing the child to the emergency immediately.
Hamman's sign is a distinct and loud sound synchronized with the heartbeat, typically observed in the precordial area. It is commonly associated with changes in body position. It’s pathognomonic for left-sided pneumothorax or pneumomediastinum. Although Hamman's sign is rarely encountered as a primary symptom, its presence is crucial for making an accurate diagnosis. Recognizing this rare clinical finding is important as it can help avoid unnecessary diagnostic tests.

Why this article important?

The authors present this case because of its rarity. We are aware that Hamman's sign is uncommon and is not typically part of the findings in a pneumothorax. However, when it is present, it should immediately raise awareness among pediatricians. This case not only underscores the significance of thorough physical examinations in pediatrics but also highlights the importance of information and suspicions provided by parents. The case we've described serves as a valuable educational example, showcasing a rare physical finding. It can be of interest to residents or students, serving as a reminder of the importance of recognizing early signs of pneumothorax or pneumomediastinum to initiate treatment promptly.

Summary of article

Hamman's sign is a rare phenomenon, however is very indicative of spontaneous pneumomediastinum and it’s considered pathognomonic for spontaneous left-side pneumothorax. So, is still a clinical finding that can’t be underestimated. A thorough physical examination in pediatrics holds a vital role in the diagnostic process, particularly if there is limited access to complementary exams. The diagnosis of a small pneumothorax can be a tricky challenge, especially if the patient is asymptomatic. In the described case, the authors present a case where the mom recognized Hamman's sign before the children started with symptoms and brought him to the hospital (twice) contributing to an early diagnosis and treatment.

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