CTICasesCOVID-19 Pneumonia with Pulmonary Interstitial Emphysema and Macklin Effect
Imaging findings
Sequential chest radiographs in an intubated COVID-19 patient demonstrate bilateral ground-glass opacities from pneumonia followed by development of bilateral pneumothoraces with visible apical air and aortic outline suggesting pneumomediastinum. CT several days later confirms extensive subcutaneous emphysema, pneumomediastinum, and bilateral pneumothoraces with chest tubes in place. Coronal images demonstrate non-anatomical air locules surrounding bronchovascular bundles in the right middle lobe consistent with pulmonary interstitial emphysema (PIE) and the Macklin effect.
Key takeaways
The Macklin effect refers to the pathway by which alveolar rupture from barotrauma produces pulmonary interstitial emphysema (PIE), which then dissects centripetally along bronchovascular sheaths into the mediastinum (pneumomediastinum), and can then rupture into the pleural space (pneumothorax). In COVID-19 ARDS, this complication is more common than in non-COVID ARDS, possibly due to unique lung mechanics. CT demonstrates air tracking along bronchovascular bundles and interlobular septa toward the mediastinum.
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