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When your patient clicks: a loud clicking sound as a key sign to the diagnosis
  1. Verena Charlotte Wilzeck1,
  2. Christopher Hansi2,
  3. Urs Hufschmid2,
  4. Juerg Hans Beer1
  1. 1Department of Internal Medicine, Kantonsspital Baden, Baden, Switzerland
  2. 2Division of Cardiology, Department of Medicine, Kantonsspital Baden, Baden, Switzerland
  1. Correspondence to Professor Juerg Hans Beer,{at}


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.

  • Respiratory Medicine
  • Valvar Diseases
  • Cardiovascular Medicine
  • Emergency Medicine
  • General Practice / Family Medicine

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  • Contributors All authors have been involved in taking care of the patient. VCW wrote the manuscript. CH, UH and JHB read and corrected the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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