Spontaneous pneumomediastinum and subcutaneous emphysema in asthma exacerbation: The Macklin effect.
OBJECTIVE
We describe the clinical features of a 17-year-old girl with severe asthma exacerbations. On admission to the intensive care unit, she manifested expiratory dyspnea, cyanosis, and an unproductive cough. Her chest x-rays showed extensive pneumomediastinum (PM), mild subcutaneous emphysema at the right anterior triangle of the neck, and right upper-lobe atelectasis. Her PM resulted from the "Macklin effect," which involves a three-step process: overly distended alveolar rupture, air dissection along the bronchovascular sheaths, and air spreading into the mediastinum.


METHODS
Treatment consisted of oxygen therapy, parenteral corticosteroids, and nebulized bronchodilators.


RESULTS
She made a good recovery, and was discharged from the intensive care unit after 2 days.


CONCLUSIONS
This case illustrates that conservative management strategies in this severe and unusual complication of asthma exacerbation can result in rapid and complete recovery. Nonetheless, every asthma exacerbation should be considered potentially life-threatening, and must be treated promptly and adequately.
Romero
Kleber J
KJ
Respiratory Care Department, Instituto Médico La Floresta, Caracas, Venezuela.
Trujillo
Máximo H
MH
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001249:Asthma / Q000150:complications* / Q000188:drug therapy / Q000628:therapy; D001784:Blood Gas Analysis; D001993:Bronchodilator Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D010102:Oxygen Inhalation Therapy; D011027:Pneumoperitoneum / Q000188:drug therapy / Q000209:etiology* / Q000628:therapy; D001261:Pulmonary Atelectasis / Q000188:drug therapy / Q000209:etiology* / Q000628:therapy; D012307:Risk Factors; D013352:Subcutaneous Emphysema / Q000188:drug therapy / Q000209:etiology* / Q000628:therapy; D013997:Time Factors
D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents