Covid Infection and Pneumomediastinum

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Angus Avagadro

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I was shown a CT chest recently of a 40+ yo morbidly obese man with ground glass infiltrates and pneumomediastinum, but he was not yet intubated. I found several case reports documenting this phenomenon, and it appears to have a poor prognosis. Any ideas on the mechanism of how this happens? I appreciate any thoughts.

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I have seen a case of mucor with hilar/mediastinal invasion in setting of COVID.

that was not a fun thoracotomy.
 
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“All 4 patients had intense repetitive episodes of dry cough; these episodes of cough are known to produce a sudden increase in distal airway pressure, causing alveolar rupture and secondary gas leakage to the peribronchovascular pulmonary interstitium, from where the air can dissect proximally, finally reaching the mediastinum. This phenomenon, called the “Macklin effect”, has been implicated as the cause of pneumomediastinum that appears in some closed thoracic lesions, asthma attacks, and Valsalva maneuvers.10, 11
 
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I was shown a CT chest recently of a 40+ yo morbidly obese man with ground glass infiltrates and pneumomediastinum, but he was not yet intubated. I found several case reports documenting this phenomenon, and it appears to have a poor prognosis. Any ideas on the mechanism of how this happens? I appreciate any thoughts.
I see this not infrequently in the covid ct PEs. I just assumed it was Macklin effect from coughing rupturing a bronchiole/bronchus and then dissecting out along the bronchial interstitial to the mediastinum.

it’s similar to what can happen in neonates with pulmonary interstitial emphysema
 
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“All 4 patients had intense repetitive episodes of dry cough; these episodes of cough are known to produce a sudden increase in distal airway pressure, causing alveolar rupture and secondary gas leakage to the peribronchovascular pulmonary interstitium, from where the air can dissect proximally, finally reaching the mediastinum. This phenomenon, called the “Macklin effect”, has been implicated as the cause of pneumomediastinum that appears in some closed thoracic lesions, asthma attacks, and Valsalva maneuvers.10, 11
Fascinating. Thanks so very much for your insight!
 
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I see this not infrequently in the covid ct PEs. I just assumed it was Macklin effect from coughing rupturing a bronchiole/bronchus and then dissecting out along the bronchial interstitial to the mediastinum.

it’s similar to what can happen in neonates with pulmonary interstitial emphysema
It all makes sense. Thank you.
 
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