Macklin Effect Research Articles

Spontaneous Pneumomediastinum in a Patient with Marijuana Use.

Spontaneous pneumomediastinum is the presence of air in the mediastinum that occurs from an unclear aetiology.Marijuana use can trigger severe vomiting in patients, leading to spontaneous pneumomediastinum through the Macklin effect.

Neumomediastino como complicación de enfermedad pulmonar intersticial en dermatomiositis

Introduction: dermatomyositis is an idiopathic, heterogenous, inflammatory myopathy, which is difficult to diagnose. It is associated with cutaneous manifestations and is considered a variable disease in terms of clinical presentation, course, and prognosis. It may involve different organs and systems, in addition to the skin and muscles. Case report: 56-year-old patient with a history of dermatomyositis who was admitted to the emergency room with dysphagia to solids and liquids, asthenia and adynamia. A thoracic CT scan evidenced pneumomediastinum and multilobar consolidations. Symptoms improved after antibiotic management and methotrexate initiation. Discussion: not many cases of pneumomediastinum in the context of interstitial disease associated with dermatomyositis have been described, thus studying this condition is relevant. The patient did not refer respiratory symptoms. The endoscopy study and esophageal CT scan did not reveal esophageal perforation, thus pneumologists attributed this clinical presentation to the Macklin effect. Conclusion: spontaneous pneumomediastinum is a rare complication carrying a high mortality rate, however it can occur in patients with interstitial lung disease.

Spontaneous pulmonary interstitial emphysema, pneumomediastinum and cervical subcutaneous emphysema secondary to the Macklin effect in dogs with no clinical signs: 12 cases

Pneumomediastinum denotes the presence of gas within the mediastinum and generally occurs by leakage of air from an aerated viscus that traverses or abuts the mediastinal plane. The Macklin effect has been described in several veterinary studies and describes gas tracking along the perivascular interstitium following alveolar rupture causing interstitial emphysema, pneumomediastinum and subsequently cervical subcutaneous emphysema. This retrospective case series describes incidental spontaneous pulmonary interstitial emphysema, pneumomediastinum and cervical subcutaneous emphysema secondary to the Macklin effect in dogs with no related clinical signs. Twelve dogs were identified from the author’s institution, of which 75 % were Sighthounds (Greyhounds, Whippets or Lurchers). Pulmonary interstitial emphysema had a predominantly paravascular distribution, although in some cases a parabronchial distribution was also identified. We conclude that incidental pulmonary interstitial emphysema, pneumomediastinum and secondary cervical subcutaneous emphysema can be incidental, presumed secondary to the Macklin effect and that Sighthound breeds may be overrepresented.

Pulmonary interstitial emphysema and spontaneous pneumomediastinum are more prevalent in sighthounds than other dog breeds undergoing thoracic CT.

Spontaneous pneumomediastinum is an uncommon condition described in veterinary medicine with concurrent respiratory disease. It can be caused by the Macklin effect, which is when gas leaks from the alveoli into the surrounding interstitial lung tissue. Pulmonary interstitial emphysema (PIE) is the presence of gas within the pulmonary vascular sheaths and indicates the presence of the Macklin effect. In the authors' experience, spontaneous pneumomediastinum and PIE are more prevalent in sighthound dogs than in other breeds and are often considered incidental findings. This retrospective, observational, cross-sectional study compared the prevalence of PIE and subsequent pneumomediastinum in sighthound with other purebred dogs. It characterized the appearance of PIE in CT and analyzed a possible association with concomitant pulmonary pathologies or with the use of general anesthesia. Medical records and thoracic CTs of sighthounds and nonsighthound dogs from two institutions were reviewed. A total of 256 dogs, comprising 127 sighthounds and 129 other purebred dogs, were included. The prevalence of PIE and pneumomediastinum was statistically higher in sighthound (14.2%) compared with other nonsighthound dogs (2.2%). There was no statistical association between the presence of PIE and pneumomediastinum with different age and weight groups or with sex. There was no statistical difference in the prevalence of PIE and pneumomediastinum between dogs with and without pulmonary pathology or in dogs undergoing CT with sedation or general anesthesia. Spontaneous pneumomediastinum in sighthounds is more prevalent than in other breeds, and its prevalence is not associated with the presence of pulmonary pathology or the use of general anesthesia.

Significant Spontaneous Pneumomediastinum and Extensive Subcutaneous Emphysema in a COVID-19 Patient

A 64-year-old man, who had no pre-existing health conditions, was admitted to the intensive care unit due to progressive shortness of breath resulting from COVID-19. Initially, the patient responded to non-invasive mechanical ventilation, which improved his breathing function. However, after six days, his respiratory function worsened significantly, requiring invasive ventilation. Out of nowhere, the person experienced spontaneous pneumomediastinum and extensive subcutaneous emphysema. The next day, a spontaneous pneumothorax occurred and was successfully drained later. It became evident that there was extensive subcutaneous emphysema also. The CT scan of the chest confirmed the presence of spontaneous pneumomediastinum, but it did not have any effect on the patient’s hemodynamics. The physicians performed a bronchoscopy and imaging with a contrast medium, which ruled out any lesions to the trachea or esophagus. No other issues related to the problem were identified during the examination. Unfortunately, microscopic bullae of interstitial emphysema, or micro air leaks, are visible when they are an adequate size on computed tomography. Recent literature and studies not available during the case report have shown that if the Macklin effect is detected on the baseline CT scan, it could predict the occurrence of pneumothorax or pneumomediastinum.

Pneumomediastinum as a primary manifestation of COVID-19: A case report

Introduction: Pneumomediastinum is a rare complication that occurs in patients with Pneumonia caused by COVID-19 and is more frequent in patients with ARDS that may or may not be related to the use of invasive mechanical ventilation. Pneumomediastinum is an indicator of clinical deterioration with potentially threatening consequences for the patient. Method: We described a case report of a 23-year-old man with Pneumomediastinum, infected with COVID-19 in conditions of respiratory failure due to interstitial pneumonia. Case presentation: A 23-year-old man, who had no pre-existing health conditions presented to the Infectious Diseases service with complaints of difficulty in breathing, dry cough, chest pain, muscle pain, joint pain, loss of taste, sore throat, pronounced body weakness, diarrhea. Symptoms started 11 days ago. On admission the patient refers that he doesn’t suffer from any other disease. The patient was not vaccinated against COVID-19. At the time of admission to the hospital, the objective examination revealed cervical subcutaneous emphysema and harsh respiration in both lungs. The nasopharyngeal swab test (RT-PCR) for Covid-19 was positive from the Institute of Public Health. The CT scan of the chest confirmed the presence of pneumomediastinum major, subcutaneous emphysema and bilateral ground glass opacities. Conclusion: Pneumomediastinum is a rare complication of pneumonia caused by Covid-19 in which the etiopathogenesis consists of severe pulmonary involvement that may or may not be affected using invasive mechanical ventilation. Timely diagnosis of pneumomediastinum in patients with Covid-19 would prevent the occurrence of life-threatening complications. Keywords: Covid-19, pneumomediastinum, ARDS, Macklin effect, vaccine.

A rare co-occurrence of spontaneous pneumomediastinum, pneumothorax, and pneumoperitoneum: Macklin effect

A rare co-occurrence of spontaneous pneumomediastinum, pneumothorax, and pneumoperitoneum: Macklin effect

The role of Macklin effect in management of ARDS: beyond spontaneous pneumomediastinum

The role of Macklin effect in management of ARDS: beyond spontaneous pneumomediastinum

EL EFECTO MACKLIN COMO COMPLICACIÓN DE ASMA NO CONTROLADA

The Macklin effect is a pulmonary air leak event caused by alveolar hyperinflation, it is rarely associated with asthma, particularly in pediatric patients. We present the case of a 9-year-old male patient without a previous diagnosis of asthma, who is hospitalized due to dry cough, deterioration in his general condition, shortness of breath, and thoracic pain, subcutaneous emphysema is detected in the neck. In the chest X-ray was observed neumomediastinum, chest tomography is performed corroborating pneumomediastinum and peribronchovascular emphysema, concluding diagnostic the Macklin effect. The patient’s treatment was based on relative rest and oxygen therapy, with appropriate improvement. The objective of this article is to report the Macklin effect as a complication of asthma exacerbation.

Macklin Effect: From Pathophysiology to Clinical Implication

Air leak syndromes (such as pneumomediastinum, pneumothorax, or subcutaneous emphysema) are frequent complications of acute respiratory distress syndrome (ARDS). Unfortunately, the development of air leaks is associated with worse outcomes. In addition, it has been hypothesized that the development of pneumomediastinum could be a marker of disease severity in patients with respiratory failure receiving noninvasive respiratory support or assisted ventilation. The so-called Macklin effect (or pulmonary interstitial emphysema) is the air dissection of the lung bronchovascular tree from peripheral to central airways following injury to distal alveoli. Ultimately, the progression of the Macklin effect leads to the development of pneumomediastinum, subcutaneous emphysema, or pneumothorax. The Macklin effect is identifiable on a chest computed tomography (CT) scan. The Macklin effect could be an accurate predictor of barotrauma in patients with ARDS (sensitivity = 89.2% [95% CI: 74.6-96.9]; specificity = 95.6% [95% CI: 90.6-98.4]), and may be a marker of disease severity. Accordingly, the detection of the Macklin effect on a chest CT scan could be used to select which patients with ARDS might benefit from different treatment algorithms, including advanced respiratory monitoring, early intubation, or, potentially, the institution of early extracorporeal support with or without invasive ventilation. In this video, the authors summarize the pathophysiology and potential clinical significance and applications of the Macklin effect in patients with acute respiratory failure.

A Case Report of Pneumoretroperitoneum from Blunt Trauma in a Patient with Chronic Obstructive Pulmonary Disease.

Pneumomediastinum is a rare complication of blunt traumatic injury and is thought to be due to the Macklin effect, a pathophysiologic process comprised of three steps: alveolar rupture secondary to blunt injury; air dissecting along bronchovascular sheaths; and spread of pulmonary interstitial edema into the mediastinal space. Pneumomediastinum is rarely associated with pneumoretroperitoneum. We present a case of a patient who suffered a cardiac arrest after a fall during a chronic obstructive pulmonary disease exacerbation, leading to pneumoretroperitoneum. This case highlights the complications that can arise from blunt trauma and how underlying lung pathology can worsen these complications.

The Macklin effect closely correlates with pneumomediastinum in acutely ill intubated patients with COVID-19 infection

PurposePatients with COVID-19 infection are frequently found to have pulmonary barotrauma. Recent work has identified the Macklin effect as a radiographic sign that often occurs in patients with COVID-19 and may correlate with barotrauma. MethodsWe evaluated chest CT scans in COVID-19 positive mechanically ventilated patients for the Macklin effect and any type of pulmonary barotrauma. Patient charts were reviewed to identify demographic and clinical characteristics. ResultsThe Macklin effect on chest CT scan was identified in a total of 10/75 (13.3%) COVID-19 positive mechanically ventilated patients; 9 developed barotrauma. Patients with the Macklin effect on chest CT scan had a 90% rate of pneumomediastinum (p < 0.001) and a trend toward a higher rate of pneumothorax (60%, p = 0.09). Pneumothorax was most frequently omolateral to the site of the Macklin effect (83.3%). ConclusionThe Macklin effect may be a strong radiographic biomarker for pulmonary barotrauma, most strongly correlating with pneumomediastinum. Studies in ARDS patients without COVID-19 are needed to validate this sign in a broader population. If validated in a broad population, future critical care treatment algorithms may include the Macklin sign for clinical decision making and prognostication.

超音波検査が診断に有用であった心嚢気腫による心タンポナーデの1例(Ultrasonographic diagnosis of cardiac tamponade due to pneumopericardium: a case report)

要旨 鋭的胸部外傷に伴う心嚢気腫は稀であるが，閉塞性ショックを生じうる緊急性の高い病態である。症例は80歳の男性。自殺企図による頸部刺創，胸部刺創でドクターヘリが要請された。病院前医療で気管損傷，左開放性血気胸に対して，気管挿管，刺創部の3点テーピング，左胸腔ドレナージを施行し当院へ搬送となった。来院後に血圧が低下し超音波検査で心嚢気腫による心タンポナーデを来していると考え，刺創部より用指的に緊急脱気を行い，速やかに血圧の上昇を得た。同日に永久気管孔を作成した。その後，心電図上ST上昇が見られたが，心筋逸脱酵素の上昇はなく冠動脈造影では冠動脈損傷などの所見はなかった。第12病日に胸腔ドレーンを抜去し，第21病日に耳鼻咽喉科へ転科し，第39病日に独歩で自宅退院した。本症例では，鋭的胸部外傷で来院後，超音波検査で心嚢気腫を疑い，心タンポナーデを来したが速やかに用指的に解除できたことが救命につながったと考えられる。

Point-of-Care Ultrasonography Helped to Rapidly Detect Pneumomediastinum in a Vomiting Female

Vomiting-induced pneumomediastinum is a rare presentation and can be a result of alveolar rupture (Mackler effect) or Boerhaave syndrome. Patients diagnosed with Boerhaave syndrome may present with the classic Mackler triad of vomiting, chest pain, and subcutaneous emphysema. However, there exists a large overlap of symptoms accompanying Boerhaave syndrome and the Macklin effect, including retrosternal chest pain, neck discomfort, cough, sore throat, dysphagia, dysphonia, and dyspnea. Boerhaave syndrome is a dangerous condition. Delayed diagnosis of Boerhaave syndrome may worsen sepsis and cause mortality. Therefore, early diagnosis and timely management are important to prevent further complications. Here, we present a case of vomiting-induced pneumomediastinum, which supports the use of bedside ultrasonography to aid in the diagnosis and rapid differentiation of etiology of pneumomediastinum.

Pneumomediastinum following immunization of BioNTech COVID-19 vaccine: A coincidence?

Background: To build immunity against the pandemic severe acute respiratory syndrome coronavirus-2 infection in adolescents, wide-ranging immunization with BioNTech (BNT) vaccine was initiated in September 2021 in Taiwan. Some adverse events are, therefore, reported after vaccination. Herein, we stated a case series with uncommon pneumomediastinum after BNT vaccination. Materials and Methods: This study retrospectively enrolled adolescents, who being diagnosed to have pneumomediastinum, during the 3-month period (between September 22, 2021, and December 22, 2021). Clinical information, such as clinical symptoms, radiographic characteristics, and clinical outcomes, were further analyzed. Results: A total of eight adolescents developed pneumomediastinum during the 3-month period after BNT vaccination. The time interval between pneumomediastinum and vaccination showed bimodal peak (around 10 and 60 days after BNT vaccination). Significant Macklin effect can be sketched in radiographic images of six patients. Conclusion: Several cases of pneumomediastinum were found in adolescents after BNT vaccination. The precise association is needed for further investigation.

SPONTANEOUS PNEUMOMEDIASTINUM: CLINICAL ANALYSIS OF 17 CASES

OBJECTIVE: Spontaneous pneumomediastinum (SPM) is a rare disease caused by the accumulation of air in the mediastinum through the tracheobronchial tree neighborhood due to alveolar rupture, which occurs spontaneously or with the effect of precipitating factors. The aim of this study is to report our experience in the diagnosis and treatment of SPM.MATERIAL AND METHODS: Seventeen patients treated with the diagnosis of SPM in a 3.5 year period were included in the study retrospectively. Age, gender, smoking, co-morbid disease status, clinical presentations, radiological imaging, treatment processes, and recurrence status were analyzed. Secondary pneumomediastinum cases were not included in the study.RESULTS: Fourteen of the patients were male, and three were female. The mean age was 19.2 ±2.8, and the mean Body Mass Index (BMI) was 18.5 ±6.3 kg/m2. The precipitating factor for SPM was found in 13 (76.5%) cases. There was a diagnosis of asthma in 4 (23.5%) cases. 9 (52.9%) cases were smokers. The most common symptom was chest pain, with 14 cases (82.4%). Subcutaneous emphysema was present in 5 (29.4%) and Hamman's sign in 2 (11.8%) cases, and the Macklin effect was detected in 3 (17.6%) cases in thorax tomography. The mean hospital stay of the cases was 4.5 ±2 days. No interventional procedures were performed, such as fiberoptic bronchoscopy, upper gastrointestinal endoscopy, pretracheal fasciotomy, or mediastinal drainage catheterization. When the antibiotic therapy rates were examined, it was seen that 13 (76.5%) cases were not given antibiotics, and no advanced complications such as mediastinitis developed in any case.CONCLUSIONS: SPM is a benign condition presenting with chest pain and dyspnea. Computed tomography is the gold standard in diagnosis, and SPM is usually treated conservatively. Although recurrence is rare, it is vital to determine the presence of an underlying secondary cause at the time of initial diagnosis.

The Macklin effect in tension pneumomediastinum in a patient with interstitial pneumonia.

Key messageTension pneumomediastinum is a rare complication of interstitial pneumonia. This case shows computed tomography findings of the Macklin effect, in which air dissection along the bronchovascular interstitium caused by alveolar rupture leads to pneumomediastinum.

Iatrogenic Pneumopericardium in a Male Full-Term Newborn with Spontaneous Pneumothorax

Abstract Neonatal pneumopericardium, a collection of air in the pericardial sac, is less common form of air leak syndrome, but unfortunately with high mortality rate. We report a rare case of male fullterm newborn who soon after birth presented with respiratory distress. Chest radiograph showed spontaneous bilateral pneumothorax after which a chest drain was placed between anterior and midaxillary line in the 5th right intercostal space. The infant soon presented with tachypnea, dyspnea, muffled heart sounds, acidosis indicating cardiorespiratory worsening. On chest radiograph ‘’Halo” sign appeared indicating pneumopericardium. We believe that spontaneous reposition of a chest drain damaged the pericardial sac which combined with ventilation mechanism (‘’Macklin effect”) most likely led to pneumopericardium. After partial chest drain extraction the infant showed signs of improvement, but had to be closely monitored due to risk of tension pneumopericardium. Careful thoracal drain placement and fixation is crucial to prevent iatrogenic pneumopericardium, which can lead to deadly tension pneumopericardium.

Non‐surgical pneumoperitoneum and pneumoretroperitoneum associated with mechanical ventilation

We present two rare cases of mechanical ventilation-associated barotrauma presenting with pneumoperitoneum and pneumoretroperitoneum separately. Pneumoperitoneum and pneumoretroperitoneum are not always associated with a hollow viscous perforation and can be seen due to barotrauma as a consequence of the Macklin effect.

Macklin effect in acute asthma exacerbation.

Macklin effect in acute asthma exacerbation.