Reverse Macklin effect

Area of Science:

• Medicine
• Pulmonology
• Radiology

Background:

• The Macklin effect describes air spreading centripetally from alveolar rupture along the peribronchovascular sheath, causing pneumomediastinum.
• This phenomenon is commonly linked to ventilator-induced barotrauma or blunt chest trauma.

Purpose of the Study:

• To report a rare case of iatrogenic tracheal injury with significant subcutaneous emphysema and pneumomediastinum.
• To propose a reversed pathophysiological sequence of the Macklin effect in this specific clinical scenario.

Main Methods:

• Case report presentation.
• Review of clinical presentation, imaging findings, and patient history.
• Pathophysiological analysis of the observed sequence of events.

Main Results:

• A patient developed massive subcutaneous emphysema and pneumomediastinum following tracheal injury.
• Air dissection occurred along the peribronchovascular interstitium, originating from the primary tracheal injury.
• Lung atelectasis resulted from compression of distal airways, without primary lung parenchymal damage.

Conclusions:

• The case suggests a potential reversal of the Macklin effect's typical pathophysiological sequence.
• Iatrogenic tracheal injury can lead to pneumomediastinum and subsequent airway compression, mimicking or altering the classic Macklin effect.
• This finding highlights the importance of considering atypical presentations of air leak syndromes after airway interventions.