CTICasesPneumomediastinum from the Macklin Phenomenon after Lung Transplant
Imaging findings
A patient a few weeks after lung transplantation, with chest or sternal discomfort, has a pneumomediastinum with a small amount of apical air (difficult to classify) and extrapleural air at other sites. Careful review shows a few linear streaks of air within interlobular septa.
Key takeaways
Linear air within interlobular septa (the black lightning bolts of septal emphysema) is substantial evidence that a pneumomediastinum arises from the Macklin phenomenon, air dissecting from the lung along interstitial sheaths. Demonstrating this pathway helps attribute the pneumomediastinum to Macklin rather than to airway or anastomotic dehiscence, head/neck, or abdominal sources in a post-transplant patient.
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