CTICasesPneumomediastinum from Macklin Phenomenon (Football Chest Trauma)
Imaging findings
A football player developed chest pain after being tackled and crunched on the field. Chest radiograph showed subtle pneumomediastinum with air outlining the mediastinum, and subsequent CT confirmed a modest amount of pneumomediastinum and pneumopericardium without evidence of interstitial or septal emphysema at the time of imaging, with no evidence of esophageal injury on a contrast study obtained to exclude esophageal perforation.
Key takeaways
Pneumomediastinum after blunt chest trauma with a closed glottis and compressed alveoli, in the absence of esophageal or tracheobronchial injury, is classic for the Macklin phenomenon (alveolar rupture with air dissecting centrally along the bronchovascular sheaths into the mediastinum). Recognizing this benign mechanism helps avoid unnecessary escalation of workup once esophageal and airway injury have been excluded.
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