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

Abstract

Key message Tension 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.

A Case of Tension Pneumomediastinum Treated With Mediastinal Drainage Using a Semi-flexible Fiberscope via a Subxiphoid Approach

“…This pathophysiologic process is known as the Macklin effect [ 4 ]. It can explain the pathogenesis of pneumomediastinum and can be associated with bronchial asthma [ 5 ], interstitial pneumonia [ 6 ], SARS-CoV-2 infection [ 7 ], barotrauma in mechanical ventilation [ 8 ], and blunt chest trauma [ 9 ]. In patients with PF, rupture of the alveoli or honeycomb cysts and subsequent air leakage into the surrounding interstitium could be regarded as the cause of pneumomediastinum [ 10 ].…”

“…Since the coronavirus disease 2019 (COVID-19) epidemic, there have been increasing reports of tension pneumomediastinum in COVID-19 patients, especially those receiving intubated ventilation [13][14][15][16]. Other reported cases of tension pneumomediastinum include those due to esophageal rupture after severe vomiting [11], tracheal perforation during cardiopulmonary resuscitation [12], and interstitial pneumonia [6].…”

Tension Pneumomediastinum in Anti-MDA5 Antibody-positive Dermatomyositis-associated Interstitial Lung Disease: A Case Report and Literature Review

“…However, a continuous increase in pressure within the mediastinum can displace the major blood vessels and the heart, leading to tension pneumomediastinum, which can result in hypotension and cardiac arrest. Table summarizes the reported cases of adult-onset tension pneumomediastinum (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31). Tension pneumomediastinum was reported to be most frequently associated with COVID-19 pneumonia and present in only two cases of CADM.…”