key: cord-0694948-x4acv3mx
authors: Marsico, Salvatore; Bellido, Luis Alexandre Del Carpio; Zuccarino, Flavio
title: Spontaneous pneumomediastinum and Macklin effect in COVID-19 patients
date: 2020-08-27
journal: Arch Bronconeumol
DOI: 10.1016/j.arbres.2020.07.030
sha: 33e85f539e6d8f92fe65fed24f93c9a550933709
doc_id: 694948
cord_uid: x4acv3mx

nan

A 71-year-old man presenting at our emergency department due to a 6-day clinic of fever of up to 38.9ºC, oropharyngeal dryness secondary to COVID-19 pneumonia.

In the preliminary evaluation it was observed an increase in the D-Dimer values (4670 ug / L). Comuputed Tomography Pulmonary Angiography (CTPA) showed a segmental pulmonary thromboemoblism (PTE) in LSD and multiple peripheral bilateral ground glass opacities compatible with viral pneumonia. CTPA also showed bilateral varicose bronchiectasias (Figure 1 . A-B).

The patient was treated with anticoagulant therapy with progressive improvement of respiratory symptoms and dicrease of D-Dimer values.

On day 19 of hospitalization the patient had a worsening of respiratory symptoms it was decided to practice a CTPA to exclude new PTE (D-Dimer 1050 ug / L).

We detected a pulmonary interstitial emphysema, with air tracking along the right peribronchovascularwith a central anterior right pneumomediastinum, that suggested pneumomediastinum secondary to a spontaneous barotrauma (Macklin effect) in a patient who was not intubated and who has not reported recent chest traumas (Figure 1 . B-C-D-F).

Pneumomediastinum secondary to barotrauma (Macklin effect) is a very an unusual pulmunary complication to our knowledge, this is the first report about pneumomediastinum secondary to barotrauma with Macklin effect in a patient affected by Covid-19 pneumonia [1-2]. 

Multiple parenchymal ground glass opacities with prevalent peripheral distribution (red arrows)