Blunt chest trauma with pneumomediastinum and pneumoperitoneum secondary to Macklin effect. Case report

Cirugia y cirujanos
Héctor Alejandro Carzolio-TrujilloJavier Herrera-Enríquez

Abstract

Pneumomediastinum is the presence of free air around mediastinal structures, which may be spontaneous or secondary, and can occur in 10% of patients with blunt chest trauma, with the Macklin effect being its main pathophysiology. A 21 year old male, hit by motor vehicle, with alvéolopalatal fracture and blunt chest trauma, who, 72 hrs after admission, shows subcutaneous emphysema in the anterior chest. A simple tomography of the chest and abdomen was performed, finding a pneumomediastinum, bilateral pulmonary contusions and pneumoperitoneum. Oesophageal, tracheobronchial or intra-abdominal viscera injuries were ruled out, establishing the cause of pneumomediastinum and pneumoperitoneum due to the Macklin effect. This required conservative management in intensive care unit, with a favourable clinical course and discharged after a 10 day hospital stay. Macklin effect is caused by dissection of air medially along the bronchoalveolar sheath (interstitial emphysema), secondary to alveolar breakdown and extending into mediastinal and other anatomical structures (pneumoperitoneum). It has been documented in blunt trauma, as well as in acute asthma, positive pressure ventilation, or after Valsalva manoeuvres. The imaging method of choi...Continue Reading

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Citations

Nov 24, 2017·European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society·Z PožgainM Danilović
Feb 13, 2021·Curēus·Ramon Vidrio DuarteJoaquin A Pimentel-Hayashi
Dec 7, 2021·Zentralblatt für Chirurgie·Sebastian ReindlStephan Raab

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