Trauma-induced “Macklin effect” with pneumothorax and large pneumomediastinum, disguised by allergy

Abstract

A 56-year-old man presented spontaneously to the Emergency Department complaining of facial and neck oedema after assumption of nonsteroidal anti-inflammatory drugs (NSAIDS). The triage nurse assigned the patient to Accident & Emergency (A&E) doctor as probable allergic reaction to NSAIDS. Chest X-ray (CXR), ordered after 24 hours, revealed a huge subcutaneous chest and neck emphysema without clearly visible pneumothorax. Subsequent chest CT scan showed a small left pneumothorax and a large amount of air in the mediastinum. The patient was conservatively treated since he was eupnoeic and hemodynamically stable. The pathophysiology of pneumomediastinum was first described by Macklin in 1939. The Macklin effect involves alveolar ruptures with air dissection along bronchovascular sheaths to the mediastinum. In this case the patient did not report in his history a recent blunt thoracic trauma and the initial suspicion of an allergic reaction has prevented physicians to immediately achieve the correct diagnosis.

Respiratory failure after superior-based pharyngeal flap for velopharyngeal insufficiency: A rare complication

“…Pneumomediastinum is thought to be caused by one of four mechanisms: (1) direct air leak from the trachea, bronchus, or esophagus; (2) perforation of a hollow abdominal viscus; (3) air tracking via the fascial planes of the neck; (4) tears in the pulmonary parenchyma with perivascular air tracking known as the Macklin effect [6]. There have been rare cases of traumatic or spontaneous pneumomediastinum reported in the pediatric population [7,8].…”

Evaluation of Lung Contusion, Associated Injuries, and Outcome in a Major Trauma Center in Shiraz, Southern Iran

“…On average, one-third of patients with thoracic trauma develop rib fractures, which increases the risk of death and disability as the number of fractured ribs increases [3]. Moreover, complications such as pneumonia, sepsis, multiorgan failure, hemorrhagic shock, and pneumomediastinum (caused by the Macklin effect) have been reported in other studies [4,5].…”

Extracorporeal membrane oxygenation rescue for severe pneumocystis pneumonia with the Macklin effect: a case report

“…Common clinical signs of PJP include fever, chest pain, dry cough, and dyspnea [ 2 ]. Severe PJP may be associated with the Macklin effect, clinically presenting as spontaneous pneumomediastinum (SPM), subcutaneous emphysema (SCE), and pneumothorax (PNX) [ 3 , 4 ]. Sherman et al [ 5 ] and Villalona-Calero et al [ 6 ] were the first to report that PNX and SPM complicated PJP in patients with AIDS.…”