Clinical use of Macklin-like radiological sign (Macklin effect): A systematic review

Belletti, Alessandro; Pallanch, Ottavia; Bonizzoni, Matteo Aldo; Guidi, Leonardo; Cobelli, Francesco De; Landoni, Giovanni; Zangrillo, Alberto; Bonis, Michele De; Palumbo, Diego

doi:10.1016/j.rmed.2023.107178

Cited by 9 publications

(5 citation statements)

References 42 publications

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“…Apart from its role for etiological purposes, Macklin effect also has prognostic value, anticipating progression to other, more severe lesions. Belletti et al 15 conducted a review of literature to assess the clinical role of Macklin. When detected on CT, this entity preceded barotrauma in 94.2% of patients with acute respiratory distress syndrome (ARDS), making it a strong predicting tool when managing these cases.…”

Section: Discussionmentioning

confidence: 99%

Laryngotracheal trauma-induced Macklin effect: A case report

Romdhane,

Chiboub,

Amri

et al. 2024

SAGE Open Medical Case Reports

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Laryngotracheal trauma is a relatively rare traumatic injury seen particularly in young male adults. Trauma due to strangulation is one of its most frequent circumstances. However rare, pneumomediastinum is a particular complication of severe blunt neck injuries leading to alveolar ruptures. This phenomenon, described as the Macklin effect, requires early diagnosis, and its management varies from conservative to surgical treatment depending on the severity of symptoms. Our aim is to describe the case of a 21-year-old male who presented with blunt neck trauma. Clinical and imaging findings revealed subcutaneous neck emphysema and pneumomediastinum. Treatment was conservative leading to complete resolution of the injuries and the patient was discharged after 2 weeks.

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Section: Discussionmentioning

confidence: 99%

Laryngotracheal trauma-induced Macklin effect: A case report

Romdhane,

Chiboub,

Amri

et al. 2024

SAGE Open Medical Case Reports

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“…4 Gas contained within the pulmonary vascular sheaths can be detected in CT images and has been referred to as pulmonary interstitial emphysema (PIE) in previous human and veterinary literature. [5][6][7][8] The veterinary literature describing spontaneous pneumomediastinum due to the Macklin effect is scarce. A case series of racing Greyhounds described spontaneous pneumomediastinum identified radiographically, suspected to be a consequence of strenuous exercise.…”

Section: Introductionmentioning

confidence: 99%

“…Once the gas is within the connective tissue, it follows the path of least resistance toward the hilus of the lung and into the mediastinum 4 . Gas contained within the pulmonary vascular sheaths can be detected in CT images and has been referred to as pulmonary interstitial emphysema (PIE) in previous human and veterinary literature 5–8 …”

Section: Introductionmentioning

confidence: 99%

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

Sánchez Jiménez,

Schofield,

Plested

2024

Vet Radiology Ultrasound

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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.

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“…Early identification of patients at risk for barotrauma according to the "Macklin effect" at CT scan, which appears as a linear collection of air tracking along with bronchovascular bundles, visceral pleura and/or interlobular septa, may allow clinicians to implement different NIRS tools and management strategies, such as early invasive ventilation or extracorporeal membrane oxygenation support [10].…”

Section: Introductionmentioning

confidence: 99%

Barotrauma during Noninvasive Respiratory Support in COVID-19 Pneumonia Outside ICU: The Ancillary COVIMIX-2 Study

Vetrugno

Deana²,

Castaldo³

et al. 2023

JCM

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Background: Noninvasive respiratory support (NIRS) has been extensively used during the COVID-19 surge for patients with acute respiratory failure. However, little data are available about barotrauma during NIRS in patients treated outside the intensive care unit (ICU) setting. Methods: COVIMIX-2 was an ancillary analysis of the previous COVIMIX study, a large multicenter observational work investigating the frequencies of barotrauma (i.e., pneumothorax and pneumomediastinum) in adult patients with COVID-19 interstitial pneumonia. Only patients treated with NIRS outside the ICU were considered. Baseline characteristics, clinical and radiological disease severity, type of ventilatory support used, blood tests and mortality were recorded. Results: In all, 179 patients were included, 60 of them with barotrauma. They were older and had lower BMI than controls (p < 0.001 and p = 0.045, respectively). Cases had higher respiratory rates and lower PaO2/FiO2 (p = 0.009 and p < 0.001). The frequency of barotrauma was 0.3% [0.1–1.3%], with older age being a risk factor for barotrauma (OR 1.06, p = 0.015). Alveolar-arterial gradient (A-a) DO2 was protective against barotrauma (OR 0.92 [0.87–0.99], p = 0.026). Barotrauma required active treatment, with drainage, in only a minority of cases. The type of NIRS was not explicitly related to the development of barotrauma. Still, an escalation of respiratory support from conventional oxygen therapy, high flow nasal cannula to noninvasive respiratory mask was predictive for in-hospital death (OR 15.51, p = 0.001). Conclusions: COVIMIX-2 showed a low frequency for barotrauma, around 0.3%. The type of NIRS used seems not to increase this risk. Patients with barotrauma were older, with more severe systemic disease, and showed increased mortality.

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Clinical use of Macklin-like radiological sign (Macklin effect): A systematic review

Cited by 9 publications

References 42 publications

Laryngotracheal trauma-induced Macklin effect: A case report

Laryngotracheal trauma-induced Macklin effect: A case report

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

Barotrauma during Noninvasive Respiratory Support in COVID-19 Pneumonia Outside ICU: The Ancillary COVIMIX-2 Study

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