Macklin effect

Case contributed by Sarah AlJahdali


Blunt trauma to the chest (snowmobile accident) a few days ago, now presenting with vomiting and mild chest pain.

Patient Data

Age: 35 years
Gender: Male

No evidence to suggest aortic injury. No mediastinal hematoma.

There is a small amount of hilar interstitial emphysema and adjacent pneumomediastinum - vomiting induced pulmonary barotrauma suspected. However, further investigation is recommended to exclude an underlying

The small pneumomediastinum could be related to the known history of vomiting due to Macklin effect, however, there is suspected mild esophageal wall thickening at the level of the carina (6 mm) with some periesophageal slightly enhancing subcentimenter lymph nodes, likely reactive. If clinically indicated, correlation with endoscopy is suggested to rule out underlying esophageal tear.

Case Discussion

In such cases, it is important to exclude other cause of pneumomediastinum such as tracheobronchial or esophageal injuries before assuming this phenomenon is related to barotrauma.

In this case, the patient's symptoms shortly subsided and the patient later underwent an outpatient endoscopy, which was negative for an esophageal injury.

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