Pneumomediastinum and Pneumoperitoneum after Blunt Chest Trauma: The Macklin Effect

When he arrived at our department his vital signs were: Blood Pressure (BP) 90/60 mmHg; Heart Rate (HR) 100 bpm; O2 Saturation (O2Sat) 43%; O2 Pressure (O2P) 30 mmHg; CO2 Pressure (CO2P) 71 mmHg; pH 7.21; blood glucose 225 mg/dl. The patient was ventilated by a Synchronized Intermittent Mandatory Ventilation (SIMV) with FiO2 100% and PEEP of 10. Two 32 Fr thoracic drains were inserted to drain both pleural spaces. They drained blood with a low evidence of air loss. He underwent a new CT scan which confirmed the first result but, in addition, demonstrated fracture of the dens epistropheus, small right-side pneumothorax (Figure 1), peritracheal pneumomediastinum with associated subcutaneous emphysema, rib fractures (VI,VII) and air in anterior abdominal region. In order to identify the cause of mediastinal air a flexible bronchoscopy was performed, with no evidence of bronchotracheal injury.