Martínez-Martínez I, Ochoa-Salmorán H, Cabrera-Palos D, Cabrera-Jardines R

Language: Spanish
References: 0
Page: 207-213
PDF size: 384.13 Kb.

ABSTRACT

Background: The Macklin effect refers to a series of events in which a pneumomediastinum occurs. Its causes can be multiple, among which are cough, Valsalva maneuver, asthma and infections, other conditions that exacerbate it are intense vomiting, closed chest trauma, hiccups and barotrauma. The most widely accepted physiopathogenesis in the development of spontaneous pneumomediastinum is secondary alveolar overdistance to high volumes, which causes ruptures. The clinical presentation can be characterized by dyspnea, respiratory distress and nasal voice. The diagnosis is corroborated with computed tomography of the thorax, evidencing the presence of perivascular and peribronchial dissection, this being evident in up to 89-100% of cases. Treatment is basically conservative, symptomatic and aimed at correcting the primary cause. Recurrence is exceptional, and it could become common in patients with a persistent cause such as asthma and interstitial pneumopathy.
Clinical case: A 46-year-old female patient, admitted with asthma exacerbation data secondary to influenza A (H1N1), complicated with pneumomediastinum, subcutaneous emphysema and pneumonia. The patient was treated conservatively with oseltamivir, supplemental oxygen, inhaled bronchodilators, inhaled steroids, with a favorable response to treatment.
Conclusions: Suspicion of Macklin effect should be in mind, because, even when the course of the disease usually is benign with total recovery, comorbidities may condition a little favorable condition.