Spontaneous Pneumomediastinum in the Postpartum Period: The Macklin Effect

Spontaneous pneumomediastinum (SPM) in the postpartum period is defined by the presence of air within the mediastinum in the absence of any apparent traumatic or iatrogenic cause. We report the case of a 32-year-old woman who developed SPM in the immediate postpartum period. Her medical history was notable only for a previous miscarriage; she had no personal or family history of asthma, atopy, or other respiratory disease. Clinically, the patient presented with acute retrosternal chest pain and sudden-onset dyspnea, accompanied by a single episode of mild hemoptysis following prolonged labor. Physical examination revealed precordial crackles synchronized with the heartbeat (Hamman's sign). Blood tests showed elevated D-dimer levels. A CT scan confirmed the diagnosis of pneumomediastinum. The patient received conservative management with low-flow oxygen therapy and close clinical and imaging monitoring, resulting in gradual resolution of symptoms and a favorable outcome.