Pneumoperitoneum and asthma

Spontaneous pneumomediastinum and subcutaneous emphysema in asthma exacerbation: The Macklin effect

OBJECTIVE

We describe the clinical features of a 17-year-old girl with severe asthma exacerbations. On admission to the intensive care unit, she manifested expiratory dyspnea, cyanosis, and an unproductive cough. Her chest x-rays showed extensive pneumomediastinum (PM), mild subcutaneous emphysema at the right anterior triangle of the neck, and right upper-lobe atelectasis. Her PM resulted from the "Macklin effect," which involves a three-step process: overly distended alveolar rupture, air dissection along the bronchovascular sheaths, and air spreading into the mediastinum.

METHODS

Treatment consisted of oxygen therapy, parenteral corticosteroids, and nebulized bronchodilators.

RESULTS

She made a good recovery, and was discharged from the intensive care unit after 2 days.

CONCLUSION

This case illustrates that conservative management strategies in this severe and unusual complication of asthma exacerbation can result in rapid and complete recovery. Nonetheless, every asthma exacerbation should be considered potentially life-threatening, and must be treated promptly and adequately.

Pneumoperitoneum recurring concomitantly with asthmatic exacerbation

We report a patient with pneumoperitoneum that recurred concomitantly with asthmatic exacerbation. The patient was a 71-year-old man with a medical history of bronchial asthma. Chest X-rays obtained during asthmatic exacerbation showed intra-abdominal air beneath his diaphragm. Subsequently, a computed tomography scan of his chest confirmed mediastinal emphysema and intra-abdominal air beneath his diaphragm. The intra-abdominal air disappeared after his asthmatic exacerbation was relieved by treatment. The patient showed recurrent pneumoperitoneum concomitant with asthmatic exacerbation. The cause of his pneumoperitoneum was conjectured to be the movement of air from the mediastinum to the peritoneal cavity through the sternocostal triangle.