CTICasesTransdiaphragmatic Air via the Foramen of Morgagni (Macklin Phenomenon)
Imaging findings
Imaging shows pneumomediastinum with chest wall and supraclavicular subcutaneous emphysema and air in the upper abdomen, which an outside report had raised as possible diaphragm rupture. Abdominal CT shows air traversing the sternocostal triangles of the foramen of Morgagni into the upper anterior extraperitoneal space, with little or no true retroperitoneal air. This was not a trauma patient and had no intra-abdominal disease.
Key takeaways
Mediastinal air can pass trans-diaphragmatically from the mediastinum into the upper anterior extraperitoneal abdomen through the sternocostal triangles of the foramen of Morgagni, a described pathway that explains upper abdominal air accompanying pneumomediastinum. Recognizing this benign route, in the setting of a Macklin phenomenon and no trauma or bowel disease, avoids the serious misdiagnosis of diaphragmatic rupture.
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