CASE 560 Published on 24.10.2000

Teaching Case

Section

Chest imaging

Case Type

Clinical Cases

Authors

M. Wintermark, P. Schnyder

Patient

43 years, female

Categories

No Area of Interest ; Imaging Technique CT ;

No Procedure ; No Special Focus ;

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Clinical History

Fall from a height

Differential Diagnosis List

Blunt traumatic Macklin effect extending into the mediastinum as a pneumopericardium

Imaging Findings

43-year-old female patient who jumped through a window and fell from a 9-m height to commit suicide

Discussion

Pneumomediastinum, also known as mediastinal emphysema, stands for free air collections surrounding mediastinal structures . It occurs in up to 10% of blunt chest trauma. In over 95% of cases, pneumomediastinum results either from extension of a subcutaneous emphysema or from alveolar rupture related to primary lung trauma or positive--pressure mechanical ventilation. Alveolar rupture is followed by centripetal dissection of the released alveolar air through the pulmonary interstitium and along the peribroncho-vascular sheaths into the mediastinum, this pathophysiological process being classically described as the “Macklin effect”. In the remaining cases, pneumomediastinum results from lesions of the trachea, bronchi or esophagus

References

[1] Jabra AA, Fishman EK, Shehata BM, Perlman EJ.
Localized persistent pulmonary interstitial emphysema: CT findings with radiographic-pathologic correlation.
AJR Am J Roentgenol. 1997 Nov;169(5):1381-4. (PMID: 9353462)

[2] : Satoh K, Kobayashi T, Kawase Y, Mitani M, Nakano S, Takahashi K, Takashima H, Ohkawa M, Tanabe M, Kojima K.
CT appearance of interstitial pulmonary emphysema.
J Thorac Imaging. 1996 Spring;11(2):153-4. (PMID: 8820025)

[3] Wintermark M, Wicky S, Schnyder P, et al
Blunt traumatic pneumomediastinum: using CT to reveal the Macklin effect.
AJR 172:129-130 (1999). (PMID: 9888752)

[4] Wintermark M, Wicky S, Bettex D, et al Trauma of the Mediastinum. In: Schnyder P, Wintermark M. Radiology of Blunt Trauma of the Chest. Springer, Berlin Heidelberg New York, pp 71-134 (2000).

Case information