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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front Med    2013, Vol. 7 Issue (3) : 386-388     DOI: 10.1007/s11684-013-0278-y
Trauma-induced “Macklin effect” with pneumothorax and large pneumomediastinum, disguised by allergy
Salomone Di Saverio1(), Kenji Kawamukai2, Andrea Biscardi1, Silvia Villani1, Luca Zucchini3, Gregorio Tugnoli1
1. Departments of Emergency and Surgery, Emergency Surgery and Trauma Surgery Unit, Trauma Center, Maggiore Hospital-Bologna Local Health District, Bologna, Italy; 2. Department of Thoracic Surgery, Trauma Center, Maggiore Hospital, Bologna, Italy; 3. Accident and Emergency, Trauma Center, Maggiore Hospital, Bologna, Italy
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A 56-year-old man presented spontaneously to the Emergency Department complaining of facial and neck oedema after assumption of nonsteroidal anti-inflammatory drugs (NSAIDS). The triage nurse assigned the patient to Accident & Emergency (A&E) doctor as probable allergic reaction to NSAIDS. Chest X-ray (CXR), ordered after 24 hours, revealed a huge subcutaneous chest and neck emphysema without clearly visible pneumothorax. Subsequent chest CT scan showed a small left pneumothorax and a large amount of air in the mediastinum. The patient was conservatively treated since he was eupnoeic and hemodynamically stable. The pathophysiology of pneumomediastinum was first described by Macklin in 1939. The Macklin effect involves alveolar ruptures with air dissection along bronchovascular sheaths to the mediastinum. In this case the patient did not report in his history a recent blunt thoracic trauma and the initial suspicion of an allergic reaction has prevented physicians to immediately achieve the correct diagnosis.

Keywords thoracic trauma      differential diagnosis      critical care      pneumothorax      pneumomediastinum; CT scan      pitfalls      lung and airways physiology     
Corresponding Authors: Saverio Salomone Di,   
Issue Date: 05 September 2013
URL:     OR
Fig.1  Plain CXR showing huge diffuse subcutaneous emphysema of the chest and neck and suspected pneumomediastinum.
Fig.2  Chest CT Scan. (A) Axial view; (B)Sagittal view; (C) Coronal view; (D) Coronal view with arrows and size measures (24 cm × 15 cm × 11 cm) .
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