{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:25:17Z","timestamp":1785284717436,"version":"3.55.0"},"reference-count":11,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2022,1,30]],"date-time":"2022-01-30T00:00:00Z","timestamp":1643500800000},"content-version":"vor","delay-in-days":29,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,1,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Vomiting-induced pneumomediastinum is often caused by oesophageal perforation or alveolar rupture due to increased pressure. A correct diagnosis is important because both diseases have different treatments and severities. We report the case of a 21-year-old man who presented with chest pain and fever after frequent vomiting and had elevated white blood cell counts on blood tests. There was extensive pneumomediastinum, and the lower oesophagus was swollen and thickened on chest computed tomography. An oesophagram was not possible due to severe nausea and vomiting. Accumulation of free air was found along the peripheral bronchi or the pulmonary vascular sheath in the left lower lobe, which was continuous with the mediastinum. Based on the presence of the Macklin effect, we diagnosed a pneumomediastinum with a high possibility of spontaneous pneumomediastinum. The Macklin effect is a finding that can likely distinguish oesophageal perforation from spontaneous pneumomediastinum.<\/jats:p>","DOI":"10.1093\/jscr\/rjab634","type":"journal-article","created":{"date-parts":[[2021,12,26]],"date-time":"2021-12-26T20:06:27Z","timestamp":1640549187000},"source":"Crossref","is-referenced-by-count":8,"title":["Spontaneous pneumomediastinum diagnosed by the Macklin effect"],"prefix":"10.1093","volume":"2022","author":[{"given":"Hirotaka","family":"Kumeda","sequence":"first","affiliation":[{"name":"Department of Thoracic Surgery, National Hospital Organization Shinshu Ueda Medical Center, Nagano, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaku","family":"Saito","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, National Hospital Organization Shinshu Ueda Medical Center, Nagano, 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tomography","volume":"30","author":"Sakai","year":"2006","journal-title":"J Comput Assist Tomogr"},{"key":"2022013013313650900_ref7","doi-asserted-by":"crossref","first-page":"1475","DOI":"10.1016\/j.athoracsur.2003.08.037","article-title":"Evolving options in the management of esophageal perforation","volume":"77","author":"Brinster","year":"2004","journal-title":"Ann Thorac Surg"},{"key":"2022013013313650900_ref8","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1186\/s13017-019-0245-2","article-title":"Esophageal emergencies: WSES guidelines","volume":"14","author":"Chirica","year":"2019","journal-title":"World J Emerg Surg"},{"key":"2022013013313650900_ref9","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1007\/s10140-020-01841-x","article-title":"Mediastinal fluid as a predictor for esophageal perforation as the cause of pneumomediastinum","volume":"28","author":"Fuhrmann","year":"2021","journal-title":"Emerg Radiol"},{"key":"2022013013313650900_ref10","doi-asserted-by":"crossref","first-page":"1711","DOI":"10.1016\/S0003-4975(03)00027-4","article-title":"Assessment of spontaneous pneumomediastinum: experience with 12 patients","volume":"75","author":"Jougon","year":"2003","journal-title":"Ann Thorac Surg"},{"key":"2022013013313650900_ref11","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1007\/s00595-006-3493-1","article-title":"Vomiting-induced pneumomediastinum and subcutaneous emphysema does not always indicate Boerhaave's syndrome: report of six cases","volume":"37","author":"Forshaw","year":"2007","journal-title":"Surg Today"}],"container-title":["Journal of Surgical Case 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