Presence of free air in pleural cavity is called as pneumothorax. Macklin effect refers to passage of air from damaged alveoli along the bronchopulmonary tracts towards proximal end & leaks to mediastinum by hilum. This case report demonstrate the timely intervention of spontaneous pneumothorax with a multi- disciplinary approach
Spontaneous pneumothorax occurs without a clear cause, such as trauma or medical intervention. It is classified into two types: primary and secondary. Primary spontaneous pneumothorax (PSP) arises in individuals without a prior history of lung disease, while secondary spontaneous pneumothorax (SSP) is linked to an existing pulmonary condition. A feared complication is tension pneumothorax. Here we present a case of primary spontaneous pneumothorax treated in our ICU.
This is about a 53-year-old female patient who had a previous stroke (left ganglio capsular bleed) now on tracheostomy with nasogastric tube feeding. Patient underwent check OGD scopy to rule out esophageal stricture. Procedure was uneventful & there were no abnormalities detected. Post procedure patient developed hypoxia in recovery room and so patient was immediately shifted to ICU. POCUS revealed absent lung sliding on right side and chest x-ray confirms the diagnosis the diagnosis of right pneumothorax with small pneumomediastinum (Fig 1). Emergency ICD was placed. Patient was gradually weaned from mechanical ventilator. Right lung has expanded in 3 days and ICD was removed subsequently and shifted to ward.
Spontaneous pneumothorax is a multifactorial process and has been associated with rises in transpulmonary pressure and defects in the visceral pleura. Acute increases in alveolar pressure that exceed the pulmonary interstitial pressure can lead to alveolar rupture and pleural air leakage (3). Furthermore, points of weakness in the visceral pleura due to subpleural blebs, bullae, lung necrosis, and other connective tissue abnormalities can predispose the alveoli to rupture in both types of spontaneous pneumothorax, though the exact mechanism of how is not entirely understood (4). Macklin effect refers to tracking of air from ruptured alveoli along the peribronchovascular interstitium towards hila and finally enters mediastinum (5,6). Small primary pneumothorax can be managed conservatively with supplemental oxygen with follow up chest radiography. Large primary pneumothorax needs chest tube insertion. Recurrent pneumothorax needs VATS.
The Macklin effect can be frequently observed on the MDCT images of patients with SPM not associated with trauma. A Macklin effect seen on CT may help differentiate respiratory from other etiologies of pneumomediastinum.
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Dr Dinesh DrNB Critical Care Medicine Trainee Kauvery Hospital Chennai
