Description
A 23-year-old Caucasian woman with a thin and tall body habitus presented to the emergency department with dizziness and chest pain. The pain had begun 12 hours before presentation without relation to exertion or trauma, radiating continuously to the neck and dorsum and being exacerbated by coughing or taking deep breaths.
The patient was previously healthy except for an episode of flu-like illness 2 weeks before presentation. She was not taking any medication and was a non-smoker. She had no relevant family history.
On clinical examination, she was conscious and reactive, afebrile and haemodynamically stable. She was eupnoeic and her oxygen saturation on pulse oximetry was 100%. Her breath sounds were normal on pulmonary auscultation, but the presence of a crunching sound synchronous with the heart beat was noted on cardiac auscultation (Hamman's sign—video 1). A discrete subcutaneous emphysema was found on palpation of the left supraclavicular...
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