Volume 1, Case 7

Hamman's Sign     
Radiology Cases in Pediatric Emergency Medicine
Volume 1, Case 7
Robert J. Butts, MD

A 20 year old male presents to the emergency department at 2:15 a.m. after awakening late at night with difficulty breathing. He initially experienced severe difficulty, but upon arrival in the ED he reported some improvement. He had some mild chest pain. He was not very communicative and declined to describe the chest pain further. He was brought in by his father who noted he was behaving differently than usual. The patient admitted to smoking crack cocaine on the day prior to arrival. He denied other illicit drug or alcohol use. His father was aware of the substance abuse and attributed his unusual behavior to this.

Exam: VS T36.6, P82, R22, BP 144/84. His oxygen saturation in room air was 100%. He was awake and alert, although he was noted to exhibit a somewhat flattened affect. He ambulated well. He exhibited a dry cough. Pertinent physical findings revealed clear lung fields. Auscultation of the heart revealed normal S1 and S2 with what was thought to be a friction rub. This was described as a fine grating sound similar to the dehiscence of Velcro. It was very brief and was noted to occur regularly with each heart beat in systole. There was no chest wall tenderness. His peripheral pulses were good. His color and perfusion were good. The remainder of the exam was unremarkable. A normal EKG was obtained. A chest radiograph was obtained to look for evidence of pericarditis.

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What is your Diagnosis?

 Loren Yamamoto, 
      MD, MPH Associate Professor of Pediatrics University of Hawaii John A. Burns 
      School of Medicine loreny@hawaii.edu