SESSION TITLE: Late-breaking Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Hamman’s syndrome can rarely coexist with pneumorrhachis when spontaneous collection of air in the mediastinum traverses through the fascial planes into the spinal canal. We report an unusual circumstance of Hamman’s syndrome developing into a pneumorrhachis in a patient after inhaled methamphetamine abuse. METHODS: A 20-year-old male presented after inhaling methamphetamine and developed severe bouts of cough and dyspnea. He also complained of neck pain that was sudden in onset and worsened with flexion and subsequent chest pain. Vitals on presentation were stable and swelling of his neck with subcutaneous crepitations in the jaw and chest were found on examination. Heart sounds were distant, but audible. Urine toxicology was positive for amphetamines. A chest x-ray revealed air around the upper mediastinum as well as periclavicular regions. A computer tomography (CT) scan showed the presence of subcutaneous emphysema and pneumomediastinum along with air column noted in the spinal canal, establishing a diagnosis of Hamman’s syndrome with pneumorrhachis. A gastrograffin study did not reveal esophageal tears or ruptures. During his admission, he was conservatively managed with serial chest x-rays showing gradual improvement in his subcutaneous emphysema. RESULTS: Hamman’s syndrome includes both subcutaneous emphysema and spontaneous pneumomediastinum (SPM). Risk factors such as coughing, vomiting and scuba diving, as well as systemic conditions such as asthma and cystic fibrosis can lead to an increase in intrathoracic pressure and alveolar rupture with dissection of air in the interstitial space, bronchovascular sheaths and subsequently to the mediastinum, also known as Macklin effect. Methamphetamine use can increase inflammatory markers such as tumor necrosis factor (TNF) alpha and IL-6, potentiating alveolar damage and risk of SPM. The combination of Hamman’s syndrome with pneumorrhachis is uncommon and occurs due to the passage of air between fascial planes from the posterior mediastinum into the neural foramina and epidural space. Examination of the patient includes auscultatory findings of pulmonary crackles synchronized with the heart sounds, known as Hamman’s sign. CT scan is considered as the gold standard imaging modality for diagnosis and anatomic localization. Treatment for uncomplicated SPM is supportive including analgesia, rest, treatment of underlying lung disease and avoidance of maneuvers that increase alveolar pressure. Surgical management is reserved for those who develop pneumorrhachis that is iatrogenic in nature or in the presence of complications such as hemodynamic instability and esophageal ruptures. CONCLUSIONS: We describe a unique case of symptomatic Hamman's syndrome and epidural pneumorrhachis secondary to methamphetamine use. CLINICAL IMPLICATIONS: Although uncommon, both these entities can be life-threatening and requires prompt evaluation and treatment. DISCLOSURES: No relevant relationships by Adhiraj Bhattacharya, source=Web Response No relevant relationships by Gahyun Gim, source=Web Response no disclosure on file for David Lee; No relevant relationships by Gemini Yesodharan, source=Web Response
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