The Macklin effect in COVID-19

Abstract

0-230). In view of the high D-dimer value, computed tomography pulmonary angiogram (CTPA) was carried out which was negative for pulmonary embolism, but revealed bilateral consolidation, extensive pneumomediastinum, surgical emphysema throughout the chest wall, and bilateral small pneumothoraces (Fig 1 ).A multidisciplinary team's opinion was to manage conservatively, to which he responded well with gradual reduction in oxygen requirement. He was eventually weaned off and was discharged on day 12. He was advised to follow up after 6 weeks. DiscussionMacklin effect has been proposed as a possible aetiology for SP in non-ventilated patients. 1,2 It starts with alveolar rupture secondary to direct alveolar injury, leading to air leaking and dissection along the bronchovascular sheaths and eventually spreading of air within the mediastinum. 3 This can also lead to subcutaneous emphysema, as seen in our patient. The most common symptom of pneumomediastinum is acute retrosternal chest pain, which warrants early alert to rule out this dreaded complication in patients with suspected or confirmed COVID-19. 2 However, our patient did not complain of retrosternal chest pain.Although the treatment for SP is usually symptomatic and conservative, oxygen therapy could possibly lead to faster recovery. 4 Loffi and colleagues consecutively studied 102 patients and found the incidence of SP to be 6%, and reported a mortality of one in six patients. 1 Although isolated pneumomediastinum might be a selflimiting condition, patients with concurrent pneumopericardium, tend to have a less favourable outcomes. [5][6][7][8] This could likely be due