Thursday, September 15, 2016


An obese (BMI 40) man with diabetes, peripheral artery disease, and tobacco abuse undergoes a CABG. He actually had a prior cardiac surgery to repair an aortic valve five years ago. Over the last year, he developed increasing shortness of breath. Workup revealed coronary disease so he underwent a redo sternotomy and bypass graft with an internal mammary artery.

Postoperatively, he has fever, tachycardia, and persistent chest pain. There is crepitus and edema of the chest wall as well as a crunching sound synchronous with the heart beat and heard by auscultation. White count is elevated.

Challenge: That weird crunching sound has a name - what is it? Also, what's the diagnosis?


Anonymous said...

Hamman's sign? Air in the mediastinum, or perhaps some pericarditis??

Anonymous said...

Pericardial rub...Dressler's syndrome

Craig Chen said...

both great answers - i was going with Hamman's sign, though a rub and Dressler's is also a great idea

This is post-operative mediastinitis, and the crunching sound is called Hamman’s sign.

Source: UpToDate.