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Case Reports
. 2017 Jun 28:2017:bcr2017220301.
doi: 10.1136/bcr-2017-220301.

When your patient clicks: a loud clicking sound as a key sign to the diagnosis

Verena Charlotte Wilzeck  1 , Christopher Hansi  2 , Urs Hufschmid  2 , Juerg Hans Beer  1
Affiliations
Case Reports

When your patient clicks: a loud clicking sound as a key sign to the diagnosis

Verena Charlotte Wilzeck et al. BMJ Case Rep. .

Abstract

A 19-year-old male patient was referred by his general practitioner with a new 'cardiac murmur'. For 1 week, he had been able to provoke a clicking sound, which was in time with his heart beat and originated from his chest. The physical examination and laboratory tests were normal. The sound was initially interpreted as most likely due to a valve condition such as mitral valve prolapse, but a transthoracic echocardiogram was normal. A cardiac CT was obtained, which showed left-sided ventral pneumothorax.The Hamman's sign is a loud precordial pulse synchronous sound, which is often postural. It is pathognomonic for left-sided pneumothorax or pneumomediastinum. Hamman's sign as a presenting symptom is rare, but if present is key to diagnosis. The awareness of rare clinical findings is important and will prevent unnecessary diagnostic tests.

Keywords: Cardiovascular Medicine; Emergency Medicine; General Practice / Family Medicine; Respiratory Medicine; Valvar Diseases.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
(A) Recording heart sounds with a mobile phone (iPhone5; Apple, Cupertino, California) using a commercial stethoscope (Littmann Master Cardiology), which was held close to the microphone for recording. (B) Waveform visualisation of the recorded audio track shows the variation of the pulse synchronous sound.
Figure 2
Figure 2
Cardiac CT showed left-sided partial pneumothorax.
See this image and copyright information in PMC

References

    1. Laennec RTH. De L’auscultation Médiate ou Traité du Diagnostic des Maladies des Poumons et du Coeur. Paris: Brosson & Chaudé, 1819.
    1. Scott JT. Mediastinal emphysema and left pneumothorax. Dis Chest 1957;32:421–34. 10.1378/chest.32.4.421 - DOI - PubMed
    1. Baumann MH, Sahn SA. Hamman's sign revisited. Pneumothorax or pneumomediastinum? Chest 1992;102:1281–2. - PubMed
    1. Wilkinson CG, Adams PC. Pneumomediastinum in a trumpeter diagnosed by the presence of Hamman's crunch. BMJ Case Rep 2012;2012:bcr2012007304 10.1136/bcr-2012-007304 - DOI - PMC - PubMed
    1. Devaraj U, Ramachandran P, D'souza GA. Recurrent spontaneous pneumomediastinum in a young female: hamman's crunch revisited(†). Oxf Med Case Reports 2014;2014:18–20. 10.1093/omcr/omu008 - DOI - PMC - PubMed

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