The Macklin Effect: Spontaneous Pneumomediastinum Reveals Asthma

Abstract

We report a case of spontaneous pneumomediastinum in an asthmatic patient. Pneumomediastinum is defined as the presence of air in the mediastinum, which may be secondary to trauma, pneumothorax, or airway perforation, or may be spontaneous. We report the case of a 28-year-old patient with emphysema mediastinum who presented with an acute exacerbation of asthma. The patient was not known to have asthma or an atopic background, had no history of surgery, and did not have any evidence of trauma or recent iatrogenicity. She presented with sudden onset of shortness of breath with chest   tightness and expectoration with green sputum. Chest auscultation revealed audible sibilant rales with subcutaneous emphysema. Chest radiographs objectify the air border along the edge of the heart contour, correlating with subcutaneous hypersharpness in the cervical region. Chest CT scan confirmed diffuse moderate pneumomediastinum. The patient received nasal oxygen, nebulized Ventolin, and received intravenous corticosteroids. The patient progressed well over three days, characterized by clinical improvement, persistent discrete sibilant rales at the apexes, and resolution of  subcutaneous emphysema to oxygen therapy and conventionnal medical treatment.