{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:47:25Z","timestamp":1760143645338,"version":"build-2065373602"},"reference-count":24,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2024,2,19]],"date-time":"2024-02-19T00:00:00Z","timestamp":1708300800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>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\u2019s 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.<\/jats:p>","DOI":"10.3390\/reports7010015","type":"journal-article","created":{"date-parts":[[2024,2,19]],"date-time":"2024-02-19T10:40:15Z","timestamp":1708339215000},"page":"15","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Significant Spontaneous Pneumomediastinum and Extensive Subcutaneous Emphysema in a COVID-19 Patient"],"prefix":"10.3390","volume":"7","author":[{"given":"Arianna","family":"Gaspari","sequence":"first","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria di Modena and Reggio Emilia, Via Del Pozzo 71, 41211 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Carrieri","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria di Modena and Reggio Emilia, Via Del Pozzo 71, 41211 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4269-6096","authenticated-orcid":false,"given":"Matteo","family":"Villani","sequence":"additional","affiliation":[{"name":"Department Anaesthesia and Intensive Care, Azienda USL Piacenza, Ospedale \u201cGuglielmo da Saliceto\u201d 49, 29121 Piacenza, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisabetta","family":"Bertellini","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria di Modena and Reggio Emilia, Via Del Pozzo 71, 41211 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,2,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e239489","DOI":"10.1136\/bcr-2020-239489","article-title":"Spontaneous pneumomediastinum, pneumothorax and subcutaneous emphysema in COVID-19 pneumonia: A rare case and literature review","volume":"13","author":"Elhakim","year":"2020","journal-title":"BMJ Case Rep."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e12935","DOI":"10.1002\/emp2.12935","article-title":"Pneumomediastinum in COVID-19 disease: Clinical review with emphasis on emergency management","volume":"4","author":"Ganessane","year":"2023","journal-title":"J. Am. Coll. Emerg. Physicians Open"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1097\/CCM.0000000000005680","article-title":"Incidence and Outcome of Pneumomediastinum in Non-ICU Hospitalized COVID-19 Patients","volume":"51","author":"Muley","year":"2023","journal-title":"Crit. Care Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.clinimag.2022.06.014","article-title":"Barotrauma in COVID 19: Incidence, pathophysiology, and effect on prognosis","volume":"90","author":"Steinberger","year":"2022","journal-title":"Clin. Imaging"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1016\/j.athoracsur.2021.03.009","article-title":"Deepening Pathology of SARS-CoV-2 Pneumonia Explains Lung Ventilation Complications","volume":"113","author":"Manenti","year":"2022","journal-title":"Ann. Thorac. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"107178","DOI":"10.1016\/j.rmed.2023.107178","article-title":"Clinical use of Macklin-like radiological sign (Macklin effect): A systematic review","volume":"210","author":"Belletti","year":"2023","journal-title":"Respir. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"106853","DOI":"10.1016\/j.rmed.2022.106853","article-title":"Macklin effect on baseline chest CT scan accurately predicts barotrauma in COVID-19 patients","volume":"197","author":"Paternoster","year":"2022","journal-title":"Respir. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1016\/S1473-3099(20)30156-0","article-title":"COVID-19 with spontaneous pneumomediastinum","volume":"20","author":"Zhou","year":"2020","journal-title":"Lancet Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1016\/j.amjms.2020.11.024","article-title":"Pneumothorax and pneumomediastinum in COVID-19: A case series","volume":"363","author":"Reyes","year":"2022","journal-title":"Am. J. Med. Sci."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Woo, W., Kipkorir, V., Marza, A.M., Hamouri, S., Albawaih, O., Dhali, A., Kim, W., Udwadia, Z.F., Nashwan, A.J., and Shaikh, N. (2022). Prognosis of Spontaneous Pneumothorax\/Pneumomediastinum in Coronavirus Disease 2019: The CoBiF Score. J. Clin. Med., 11.","DOI":"10.3390\/jcm11237132"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1586","DOI":"10.1016\/j.acra.2021.07.013","article-title":"Spontaneous Pneumomediastinum in Patients Diagnosed with COVID-19: A Case Series with Review of Literature","volume":"28","author":"Chowdhary","year":"2021","journal-title":"Acad. Radiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.clinimag.2020.08.013","article-title":"Spontaneous subcutaneous emphysema and pneumomediastinum in non-intubated patients with COVID-19","volume":"67","author":"Manna","year":"2020","journal-title":"Clin. Imaging"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1164\/rccm.202105-1179IM","article-title":"Spontaneous Pneumomediastinum in COVID-19: The Macklin Effect?","volume":"204","author":"Sekhon","year":"2021","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Lee, J.W., Chun, W., Lee, H.J., Min, J.H., Kim, S.M., Seo, J.Y., Ahn, K.S., and Oh, S.R. (2021). The Role of Macrophages in the Development of Acute and Chronic Inflammatory Lung Diseases. Cells, 10.","DOI":"10.3390\/cells10040897"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1164\/rccm.201606-1306OC","article-title":"Noninvasive Ventilation of Patients with Acute Respiratory Distress Syndrome. Insights from the LUNG SAFE Study","volume":"195","author":"Bellani","year":"2017","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1145","DOI":"10.1016\/S0140-6736(22)01485-4","article-title":"Acute respiratory distress syndrome: Causes, pathophysiology, and phenotypes","volume":"400","author":"Bos","year":"2022","journal-title":"Lancet"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1016\/j.ccc.2021.05.003","article-title":"Pathophysiology of Acute Respiratory Distress Syndrome and COVID-19 Lung Injury","volume":"37","author":"Swenson","year":"2021","journal-title":"Crit. Care Clin."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2136","DOI":"10.1007\/s00134-020-06296-9","article-title":"Phenotypes and personalized medicine in the acute respiratory distress syndrome","volume":"46","author":"Matthay","year":"2020","journal-title":"Intensive Care Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1016\/j.athoracsur.2008.04.067","article-title":"Spontaneous pneumomediastinum: A comparative study and review of the literature","volume":"86","author":"Caceres","year":"2008","journal-title":"Ann. Thorac. Surg."},{"key":"ref_20","first-page":"110","article-title":"Spontaneous pneumomediastinum in COVID-19 patients. Case series","volume":"157","year":"2021","journal-title":"Gac. M\u00e9d. M\u00e9x."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1608","DOI":"10.4081\/monaldi.2021.1608","article-title":"Pneumothorax and pneumomediastinum in COVID-19 acute respiratory distress syndrome","volume":"91","author":"Lal","year":"2021","journal-title":"Monaldi Arch. Chest Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1097\/CCM.0000000000005283","article-title":"Barotrauma in Coronavirus Disease 2019 Patients Undergoing Invasive Mechanical Ventilation: A Systematic Literature Review","volume":"50","author":"Belletti","year":"2022","journal-title":"Crit. Care Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1097\/CCM.0000000000005291","article-title":"Bursting at the Seams: Barotrauma in Coronavirus Disease 2019 Acute Respiratory Distress Syndrome Patients","volume":"50","author":"Hossain","year":"2022","journal-title":"Crit. Care Med."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Marza, A.M., Cindrea, A.C., Petrica, A., Stanciugelu, A.V., Barsac, C., Mocanu, A., Critu, R., Botea, M.O., Trebuian, C.I., and Lungeanu, D. (2023). Non-Ventilated Patients with Spontaneous Pneumothorax or Pneumomediastinum Associated with COVID-19: Three-Year Debriefing across Five Pandemic Waves. J. Pers. Med., 13.","DOI":"10.3390\/jpm13101497"}],"container-title":["Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2571-841X\/7\/1\/15\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:02:25Z","timestamp":1760104945000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2571-841X\/7\/1\/15"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,19]]},"references-count":24,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,3]]}},"alternative-id":["reports7010015"],"URL":"https:\/\/doi.org\/10.3390\/reports7010015","relation":{},"ISSN":["2571-841X"],"issn-type":[{"type":"electronic","value":"2571-841X"}],"subject":[],"published":{"date-parts":[[2024,2,19]]}}}