Spontaneous Pneumomediastinum and Macklin Effect in COVID-19 Patients

Marsico, Salvatore; Bellido, Luis Alexander Del Carpio; Zuccarino, Flavio

doi:10.1016/j.arbres.2020.07.030

Cited by 14 publications

(12 citation statements)

References 2 publications

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“…On day 12, (chest pain): chest CT showed parenchymal consolidation and scattered pneumomediastinum RT-PCR + COVID Oxygen, gamma globulin, antibiotics, antiviral, steroid bronchodilators. Recovered Salvatore Marsico 35 27 Aug 2020 71 Male None Fever CTPA: pulmonary thromboembolism and multiple peripheral bilateral GGO and bronchiectasis. On day 19 CTA: pulmonary interstitial emphysema and pneumomediastinum.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Pneumomediastinum in Patients Diagnosed with COVID-19: A Case Series with Review of Literature

et al. 2021

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Spontaneous pneumomediastinum is a rare condition defined by the presence of air in the mediastinum in the absence of traumatic or iatrogenic. Although the imaging findings and complications of SARS-CoV-2 infection have been reported many times, there are few reports of the prevalence and outcomes of patients with spontaneous pneumomediastinum. In this paper, we aimed to illustrate the different manifestations, management, and outcome of three cases of SPM in COVID-19 patients and provide an extensive review of 22 related published case reports and series of 35 patients. Statistical analysis of the reviewed articles showed that SPM in COVID-19 occurs in patients with a mean age of 55.6 ± 16.7 years. Furthermore, 80% of the 35 patients are males and almost 60% have comorbidities. Intriguingly, SPM in COVID-19 is associated with a 28.5% mortality rate. These findings are consistent with our case series and are different from previous reports of SPM in non-COVID-19 cases where it most commonly occurs in younger individuals and has a self-limiting course with a good outcome. Therefore, SPM in COVID-19 patients occurs in older patients and is potentially associated with a higher mortality rate. Further studies are necessary to assess its role as a prognostic marker of poor outcome.

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Section: Discussionmentioning

confidence: 99%

Spontaneous Pneumomediastinum in Patients Diagnosed with COVID-19: A Case Series with Review of Literature

et al. 2021

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“…A finding that caught our attention was that the peripheral Macklin effect was located on the left in all of our patients. The CT Macklin effect has been mentioned in few other reports on COVID-19 patients [ 13 , 29 , 39 ].…”

Section: Discussionmentioning

confidence: 97%

Spontaneous pneumomediastinum and COVID-19 pneumonia: Report of three cases with emphasis on CT imaging

Kalpaxi

Kalokairinou

Katseli

et al. 2021

Radiology Case Reports

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Spontaneous pneumomediastinum (SPM) is a rare complication of coronavirus disease 2019 (COVID-19). The published literature consists mainly of case reports and small case series. There are still many questions regarding the pathogenesis, the prognostic significance and the implications on patient management. In our hospital three COVID-19 patients developed SPM: one on admission at the emergency department and the other two during hospitalization. In this study we describe their clinical course and computed tomography (CT) findings. All of them had severe disease according to the total severity score on admission CT. The management of pneumomediastinum was conservative and follow-up CT showed resolution in all patients. As the correlation between extension of parenchymal lung lesions and development of pneumomediastinum is still under investigation, we highlight the importance of reporting the severity score on chest CT in order to obtain more comparable results between different studies. Furthermore, in this tragic circumstance we also had the opportunity to familiarize ourselves with the otherwise uncommon occurrence of air along the bronchovascular sheaths (Macklin effect) and evaluate the ability of CT to detect it.

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“…The mechanism for SPM is thought to be related to alveolar rupture and interstitial emphysema from diffuse alveolar damage, causing extrapulmonary air to dissect along the perivascular and peribronchial connective tissue sheaths into the mediastinum, described as the Macklin effect [1,2]. Increased alveolar pressure and subsequent alveolar rupture can be attributed to coughing, which was present in most of the cases of SPM from the literature.…”

Section: Discussionmentioning

confidence: 99%

Isolated Spontaneous Pneumomediastinum in COVID-19 Patients: Case Series and Review of the Literature

Chen¹,

Roth²,

Thomas³

et al. 2021

J Med Imaging Case Rep

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While isolated spontaneous pneumomediastinum (SPM) is not commonly associated with viral respiratory infections, several cases of isolated SPM in the context of coronavirus disease 2019 (COVID-19) have emerged. Isolated SPM remains seldom presented in the current literature. We will present the clinical presentation and hospital course of isolated SPM in four patients hospitalized with COVID-19 who were not on mechanical ventilation. We will also review all cases from the current literature and compare these cases for similarities and possible patterns that may help elucidate risk factors for developing SPM. Increased use of high-flow oxygen in COVID-19 management may be a potential contributing factor to the SPM development. Isolated SPM can be an indicator of disease severity and worse prognosis.

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Spontaneous Pneumomediastinum and Macklin Effect in COVID-19 Patients

Cited by 14 publications

References 2 publications

Spontaneous Pneumomediastinum in Patients Diagnosed with COVID-19: A Case Series with Review of Literature

Spontaneous Pneumomediastinum in Patients Diagnosed with COVID-19: A Case Series with Review of Literature

Spontaneous pneumomediastinum and COVID-19 pneumonia: Report of three cases with emphasis on CT imaging

Isolated Spontaneous Pneumomediastinum in COVID-19 Patients: Case Series and Review of the Literature

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