title: Hamman and Boerhaave syndromes - diagnostic dilemmas in a patient presenting with hyperemesis gravidarum: a case report.
abstract: BACKGROUND
  Hyperemesis gravidarum describes persistent vomiting leading to fluid and electrolyte imbalance. It is the commonest reason for admission in the first half of pregnancy. We describe a case of Hamman syndrome secondary to hyperemesis gravidarum. We also discuss Boerhaave syndrome: a particularly rare condition with only a handful of cases being described in the literature.
  
  
  METHODS
  A 17 year old admitted with hyperemesis gravidarum was diagnosed with Hamman syndrome after complaining of chest pain due to the presence of subcutaneous emphysema and pneumomediastinum on chest radiograph. She was treated conservatively for potential ruptured oesophagus but then self-discharged against medical advice.
  
  
  CONCLUSIONS
  Subcutaneous emphysema is an alarming finding in any pregnancy and should be treated in a timely and cautious manner. This case report adds weight to the previous literature advocating a conservative versus surgical approach to the management of a woman with Hamman syndrome secondary to hyperemesis gravidarum.
authors.affiliation: Specialty Trainee in Obstetrics and Gynaecology, Department of Obstetrics and Gynaecology, University Hospital Crosshouse, UK gordonbuchanan1@nhs.net.
authors.forename: Gordon M
authors.initials: GM
authors.lastname: Buchanan
authors.affiliation: Consultant Obstetrician and Gynaecologist, Department of Obstetrics and Gynaecology, University Hospital Crosshouse, UK.
authors.forename: Vivian
authors.initials: V
authors.lastname: Franklin
mesh_terms: D000293:Adolescent; D000897:Anti-Ulcer Agents / Q000008:administration & dosage; D000932:Antiemetics / Q000008:administration & dosage; D002637:Chest Pain / Q000209:etiology*; D019970:Cocaine-Related Disorders / Q000150:complications*; D004939:Esophageal Perforation / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D005440:Fluid Therapy / Q000379:methods; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage; D006801:Humans; D006939:Hyperemesis Gravidarum / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D008477:Mediastinal Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D011247:Pregnancy; D011899:Ranitidine / Q000008:administration & dosage; D053828:Stockings, Compression; D013352:Subcutaneous Emphysema / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D004935:Esophageal Diseases; D012422:Rupture, Spontaneous; D000072663:Spontaneous Perforation
chemical_list: D000897:Anti-Ulcer Agents; D000932:Antiemetics; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D011899:Ranitidine
keywords: Boerhaave syndrome; Hamman syndrome; Hyperemesis gravidarum; subcutaneous emphysema