{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T12:21:12Z","timestamp":1777551672480,"version":"3.51.4"},"reference-count":15,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2021,4,14]],"date-time":"2021-04-14T00:00:00Z","timestamp":1618358400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Asian Cardiovasc Thorac Ann"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>Pneumomediastinum (PM) is associated with several etiologies and mechanisms. Although it has been described more than 100 years ago, the literature is limited to small retrospective studies. This study aimed to follow patients with coronavirus disease (COVID-19) that developed PM during hospitalization and describe their clinical and radiological evolution.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A prospective cohort was developed with patients with PM, excluding those with aerodigestive trauma, inside a hospital COVID-19 dedicated hospital. Clinical variables including onset of symptoms, hemodynamic instability, associated complications, the need of interventions, and disease course were all recorded. Also, radiological findings such as the presence of the Macklin effect, extension of lung involvement by COVID-19, and characteristics of the PM were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty-one patients with non-traumatic PM were followed, resulting in an overall incidence of 0.5% during the study period. Seven (33%) patients had associated pneumothorax and malignant\/tension PM was observed in three (14%) cases. The Macklin effect could be found in 11 patients (52%) and the majority of them had more than 50% of lung involvement due to COVID-19. The mortality rate was 49%; however, no deaths were directly related to the PM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PM incidence is probably increased in the severe acute respiratory syndrome caused by COVID-19, especially in those with greater involvement of the lungs, and the Macklin effect may be an important underlying mechanism of this complication. Usually, PM has a benign course, but complications like tension\/malignant PM may occur requiring prompt detection and intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/02184923211010089","type":"journal-article","created":{"date-parts":[[2021,4,15]],"date-time":"2021-04-15T01:16:33Z","timestamp":1618449393000},"page":"541-548","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":20,"title":["Pneumomediastinum in COVID-19 disease: Outcomes and relation to the Macklin effect"],"prefix":"10.1177","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0134-9357","authenticated-orcid":false,"given":"Jo\u00e3o","family":"Brito","sequence":"first","affiliation":[{"name":"Division of Thoracic Surgery, Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paulo","family":"Greg\u00f3rio","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3004-1351","authenticated-orcid":false,"given":"Alessandro","family":"Mariani","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paula","family":"D\u2019ambrosio","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mauro","family":"Filho","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorena","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Division of Radiology, Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcio","family":"Sawamura","sequence":"additional","affiliation":[{"name":"Division of Radiology, Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paulo Manuel","family":"P\u00eago-Fernandes","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2021,4,14]]},"reference":[{"key":"bibr1-02184923211010089","doi-asserted-by":"publisher","DOI":"10.12746\/swrccc.v7i27.524"},{"key":"bibr2-02184923211010089","first-page":"S44","volume":"7","author":"Kouritas VK","year":"2015","journal-title":"J Thorac Dis"},{"key":"bibr3-02184923211010089","doi-asserted-by":"publisher","DOI":"10.1016\/j.resinv.2013.06.001"},{"key":"bibr4-02184923211010089","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.04.00096404"},{"key":"bibr5-02184923211010089","doi-asserted-by":"crossref","unstructured":"Suwanwongse K, Shabarek N. Pneumomediastinum in mechanically ventilated coronavirus disease 2019 patients.\n                      J Cardiothorac Vasc Anesth\n                      , https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S1053077020306005 (2020, accessed 02 April 2021).","DOI":"10.1053\/j.jvca.2020.06.058"},{"key":"bibr6-02184923211010089","doi-asserted-by":"crossref","unstructured":"L\u00f3pez Vega JM, Parra Gordo ML, Diez Tasc\u00f3n A, et\u00a0al. Pneumomediastinum and spontaneous pneumothorax as an extrapulmonary complication of COVID-19 disease.\n                      Emerg Radiol\n                      . http:\/\/link.springer.com\/10.1007\/s10140-020-01806-0 (2020, accessed 02 April 2021).","DOI":"10.1007\/s10140-020-01806-0"},{"key":"bibr7-02184923211010089","doi-asserted-by":"publisher","DOI":"10.1177\/1751143716662665"},{"key":"bibr8-02184923211010089","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2008.08.009"},{"key":"bibr9-02184923211010089","doi-asserted-by":"publisher","DOI":"10.1378\/chest.120.2.543"},{"key":"bibr10-02184923211010089","doi-asserted-by":"publisher","DOI":"10.1097\/01.rct.0000187416.07698.8d"},{"key":"bibr11-02184923211010089","doi-asserted-by":"crossref","unstructured":"Simpson S, Kay FU, Abbara S, et al. Radiological Society of North America expert consensus document on reporting chest CT findings related to COVID-19: endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA.\n                      Radiology: Cardiothorac Imag\n                      2020; 2(2): e200152.","DOI":"10.1148\/ryct.2020200152"},{"key":"bibr12-02184923211010089","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"bibr13-02184923211010089","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-54-1-46"},{"key":"bibr14-02184923211010089","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)13413-7"},{"key":"bibr15-02184923211010089","doi-asserted-by":"publisher","DOI":"10.1016\/S0025-6196(11)60560-0"}],"container-title":["Asian Cardiovascular and Thoracic Annals"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/02184923211010089","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/02184923211010089","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/02184923211010089","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T17:55:29Z","timestamp":1777398929000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/02184923211010089"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,14]]},"references-count":15,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2021,7]]}},"alternative-id":["10.1177\/02184923211010089"],"URL":"https:\/\/doi.org\/10.1177\/02184923211010089","relation":{},"ISSN":["0218-4923","1816-5370"],"issn-type":[{"value":"0218-4923","type":"print"},{"value":"1816-5370","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,14]]}}}