CTICasesMacklin Phenomenon via the Pulmonary Vein Sheath
Imaging findings
A young person who presented after severe vomiting has pneumomediastinum, subcutaneous emphysema, and right lung opacities consistent with aspiration. Air is seen tracking within the connective tissue sheath surrounding the inferior pulmonary veins into the mediastinum, and there is a small apical collection of extrapleural (not intrapleural) air, recognizable by the tissue between it and the pleural surface.
Key takeaways
In the Macklin phenomenon, air dissects from the lung to the mediastinum not only along the sheaths of the bronchoarterial bundles but also, as illustrated here, along the connective tissue sheaths surrounding the pulmonary veins. Recognizing that apical air lies in the extrapleural space (a pseudo-pneumothorax) rather than the pleural space, based on intervening tissue, avoids over-calling a pneumothorax.
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