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Reverse Macklin effect.

Rohan Reddy Chinthareddy1, Karthik Ashok2, Srirangapatna Varadaraj Srikrishna1

  • 1Department of Thoracic Surgery, Mazumdar Shaw Medical Centre, Narayana Health City, 258/A, Hosur Road, Bommasandra Industrial Area, Bengaluru, Karnataka 560099 India.

Indian Journal of Thoracic and Cardiovascular Surgery
|September 2, 2022
PubMed
Summary
This summary is machine-generated.

This study presents a unique case where tracheal injury caused pneumomediastinum and air dissection, leading to lung atelectasis. This reversed the typical Macklin effect sequence, offering new insights into iatrogenic airway injuries.

Keywords:
Peribronchial interstitial emphysemaPneumomediastinumTracheal injury

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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.