CTICasesMacklin Effect
Imaging findings
Chest CT in an intubated patient shows extensive subcutaneous emphysema and pneumomediastinum. Linear tracts of air are seen dissection along the bronchovascular sheaths (Macklin effect). The air tracks anteriorly across the sternocostal diaphragmatic attachments into the preperitoneal and retroperitoneal spaces of the upper abdomen, mimicking pneumoperitoneum.
Key takeaways
The Macklin effect describes the pathophysiological pathway of alveolar rupture, where air dissects along the bronchovascular sheaths into the mediastinum (pneumomediastinum). In patients on mechanical ventilation, this air can track inferiorly through the diaphragmatic sternocostal hiatuses into the retroperitoneum. Recognizing this benign pathway prevents unnecessary laparotomy for suspected bowel perforation.
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