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      Spontaneous pneumomediastinum and Macklin effect: Overview and appearance on computed tomography

      World Journal of Radiology
      Baishideng Publishing Group Inc.

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          Abstract

          Spontaneous pneumomediastinum (SPM) is described as free air or gas located within the mediastinum that is not associated with any noticeable cause such as chest trauma. SPM has been associated with many conditions and triggers, including bronchial asthma, diabetic ketoacidosis, forceful straining during exercise, inhalation of drugs, as well as other activities associated with the Valsalva maneuver. The Macklin effect appears on thoracic computed tomography (CT) as linear collections of air contiguous to the bronchovascular sheaths. With the recent availability of multidetector-row CT, the Macklin effect has been seen in the clinical setting more frequently than expected. The aim of this review article is to describe the CT imaging spectrum of the Macklin effect in patients with SPM, focusing on the common appearance of the Macklin effect, pneumorrhachis, and persistent SPM with pneumatocele.

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          Most cited references30

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          Spontaneous pneumomediastinum: a benign curiosity or a significant problem?

          To identify the significance of spontaneous pneumomediastinum (SPM) and to optimize its management. A retrospective analysis was undertaken of all patients presenting with SPM over a 5-year period. Eighteen patients were identified, and information on their presentations, initial diagnoses, comorbidities, investigations, clinical courses, length of hospital stays, and outcomes were collated. The emergency department referrals of two major Melbourne teaching hospitals. SPM is an uncommon condition presenting in approximately 1 in 30,000 emergency department referrals. The typical patient identified from this study is a young man who is likely to have a history of asthma, and who is also likely to smoke or to use illicit drugs. The most common presentation is nonspecific pleuritic chest pain with dyspnea. Complications are rare, and the clinical course benign, but the possibility of a ruptured viscus or an initial misdiagnosis often leads to a great number of investigations. A proposed algorithm of management is given. Other serious and potentially life-threatening conditions, such as Boerhaave syndrome need to be excluded.
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            MALIGNANT INTERSTITIAL EMPHYSEMA OF THE LUNGS AND MEDIASTINUM AS AN IMPORTANT OCCULT COMPLICATION IN MANY RESPIRATORY DISEASES AND OTHER CONDITIONS

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              Assessment of spontaneous pneumomediastinum: experience with 12 patients.

              The aim of this study is to report a series of spontaneous pneumomediastinum in a population of young, tall, and thin patients with a history of thoracic hyper pressure, and to analyze the assessment required in such patients. A retrospective study of an unicentric series and a review of the literature from 1980 to 2002 were performed. Between December 1996 and January 2002, 12 patients (mean age, 25 years old; mean height, 172 cm; and mean weight, 63 kg) were admitted with spontaneous pneumomediastinum. In all patients, high intrathoracic pressure by cough or acute effort was the precipitating factor. Most frequent complaints were acute chest pain, asthenia, and subcutaneous emphysema. The following assessment was performed: chest roentgenogram in 12 of 12 patients (12/12); computer tomography (CT) scan in 8/12; bronchoscopy in 7/12; esophagoscopy in 6/12; esophagography in 2/12. Outcome was always uneventful without any recurrence. Hospital stay ranged from 0 to 6 days. The Medline research revealed that articles consist mainly of case reports. Two articles only report a multicentric series of 25 and 36 cases, respectively. No organ perforation was found either in our series or in our review of the literature. Spontaneous pneumomediastinum follows alveolar rupture in the pulmonary interstitium. The dissection of gas towards the hilum and mediastinum is produced by an episode of acute high intrathoracic pressure. It affects mostly young people, and this is the case in our series. Endoscopic thoracic assessment may be risky and is not always necessary. Chest CT or esophageal contrast study should be performed in case of diagnostic doubt of esophageal perforation.
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                Author and article information

                Journal
                applab
                World Journal of Radiology
                WJR
                Baishideng Publishing Group Inc.
                1949-8470
                2014
                2014
                : 6
                : 11
                : 850
                Article
                10.4329/wjr.v6.i11.850
                4241491
                25431639
                760692ea-dea0-49c4-848e-be74e3b67801
                © 2014
                History

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