Case Studies in Critical CareSpontaneous pneumomediastinum and subcutaneous emphysema in asthma exacerbation: The Macklin effect
Section snippets
Case Report
A 17-year-old girl was admitted to our emergency department because of a severe asthma exacerbation. She had developed asthma at age 7 years, and her exacerbations had occurred frequently, usually triggered by exposure to cold air and/or physical activities. Her asthma was classified as not well-controlled.7 Her medical treatment consisted of budesonide/formoterol metered dose inhaler 80 μg/4.5 μg, two inhalations twice daily (dose dependent on severity of asthma), and oral prednisone.
Discussion
Pneumomediastinum can be divided into two groups: SPM without an obvious primary source, and secondary pneumomediastinum with a specific, demonstrable, responsible pathological event such as trauma, intrathoracic infections, esophageal perforation, and others.8
Spontaneous PM is an uncommon clinical entity. In asthmatic patients, this complication is considered rare, with an incidence of 0.2% to 0.3%.9, 10, 11 Its course is usually favorable, with no other complications. The more common
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Macklin Effect: From Pathophysiology to Clinical Implication
2024, Journal of Cardiothoracic and Vascular AnesthesiaClinical use of Macklin-like radiological sign (Macklin effect): A systematic review
2023, Respiratory MedicinePneumomediastinum as a complication of a near-fatal asthmatic crisis in a young patient: Case report
2022, Acta Colombiana de Cuidado IntensivoA radiological predictor for pneumomediastinum/pneumothorax in COVID-19 ARDS patients
2021, Journal of Critical CareCitation Excerpt :Once the gas is in the mediastinum, it can then track to the cervical soft tissues (subcutaneous emphysema) or into the abdomen (pneumoperitoneum). A broad alveolar collapse might significantly reduce pulmonary compliance, possibly resulting in lung parenchyma rupture (PNX), not necessarily at the level of the alveoli primarily affected by the pressure gradient issue [16]. It follows that PNX represents the macroscopic outcome of a severe Macklin effect, and this is consistent with our data since we have observed no false positive results in patients with later PNX development (100% sensitivity, 100% NPV): a higher number of alveoli involved causes a larger air leakage along the pulmonary interstitium, resulting in a better recognizable Macklin effect on CT images.
Spontaneous pneumomediastinum in the pediatric patient
2015, American Journal of SurgeryCitation Excerpt :Given the paucity of published data or treatment algorithms for SPM in children,2,6 this new information may assist physicians in their approach and management of children with SPM. As most reports on SPM are limited to small case series mixing adults and children7,8 or pediatric case series and/or case reports,7,9–12 the majority have focused on patient presentation. Patients often present with cough or shortness of breath.2,5,8,11,13,14