Gaspari Arianna, Carrieri Francesca, Villani Matteo, Bertellini Elisabetta
Department of Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria di Modena and Reggio Emilia, Via Del Pozzo 71, 41211 Modena, Italy.
Department Anaesthesia and Intensive Care, Azienda USL Piacenza, Ospedale "Guglielmo da Saliceto" 49, 29121 Piacenza, Italy.
Reports (MDPI). 2024 Feb 19;7(1):15. doi: 10.3390/reports7010015.
A 64-year-old man, who had no pre-existing health conditions, was admitted to the intensive care unit due to progressive shortness of breath resulting from COVID-19. Initially, the patient responded to non-invasive mechanical ventilation, which improved his breathing function. However, after six days, his respiratory function worsened significantly, requiring invasive ventilation. Out of nowhere, the person experienced spontaneous pneumomediastinum and extensive subcutaneous emphysema. The next day, a spontaneous pneumothorax occurred and was successfully drained later. It became evident that there was extensive subcutaneous emphysema also. The CT scan of the chest confirmed the presence of spontaneous pneumomediastinum, but it did not have any effect on the patient's hemodynamics. The physicians performed a bronchoscopy and imaging with a contrast medium, which ruled out any lesions to the trachea or esophagus. No other issues related to the problem were identified during the examination. Unfortunately, microscopic bullae of interstitial emphysema, or micro air leaks, are visible when they are an adequate size on computed tomography. Recent literature and studies not available during the case report have shown that if the Macklin effect is detected on the baseline CT scan, it could predict the occurrence of pneumothorax or pneumomediastinum.
一名64岁的男性，之前没有健康问题，因新型冠状病毒肺炎导致进行性呼吸急促而入住重症监护病房。最初，患者对无创机械通气有反应，呼吸功能得到改善。然而，六天后，他的呼吸功能显著恶化，需要有创通气。毫无征兆地，该患者出现了纵隔气肿和广泛的皮下气肿。第二天，发生了自发性气胸，随后成功进行了引流。显然也存在广泛的皮下气肿。胸部CT扫描证实存在纵隔气肿，但对患者的血流动力学没有任何影响。医生进行了支气管镜检查和造影成像，排除了气管或食管的任何病变。检查期间未发现与该问题相关的其他问题。不幸的是，当间质性肺气肿的微小肺大疱或微小气漏在计算机断层扫描上尺寸足够大时才可见。在病例报告期间没有可获取的最新文献和研究表明，如果在基线CT扫描上检测到麦克林效应，可能预测气胸或纵隔气肿的发生。
