CTICasesSpontaneous Pneumomediastinum and Pneumoretroperitoneum due to Macklin Phenomenon
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Imaging findings
Chest radiography and CT demonstrate extensive subcutaneous emphysema, pneumomediastinum, and a highly dramatic case of pneumoretroperitoneum with air dissecting around the kidneys, psoas muscles, and down into the scrotum and upper legs. Subtle findings of pulmonary interstitial emphysema along the intersublobar septum, and pneumorachis with air dissecting along the spinal canal and nerve roots are also visible. Esophageal contours appear normal with no associated pleural effusions.
Key takeaways
Spontaneous subcutaneous emphysema, pneumomediastinum, and pneumoretroperitoneum in a young patient with psychiatric symptoms or erratic behavior is highly suggestive of the Macklin phenomenon. This process is initiated by alveolar rupture leading to air tracking along the bronchovascular sheaths (pulmonary interstitial emphysema) into the mediastinum, retroperitoneum, spinal canal, and subcutaneous tissues. In the absence of trauma, esophageal tear (Boerhaave syndrome), or infection, it is managed conservatively and typically resolves spontaneously.
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