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Imagen Clínica
Enfisema peribroncovascular. Efecto Macklin
Peribronchovascular Emphysema. The Macklin Effect
Antía Ferreiroa, Galo Granadosa, Ana Villara,b,c,
Corresponding author
avillar@vhebron.net

Autor para correspondencia.
a Servicio de Neumología, Hospital Universitari Vall d’Hebron, Barcelona, España
b CIBER Enfermedades Respiratorias (CIBERES), Madrid, España
c Vall d’Hebron Institut de Recerca (VHIR), Barcelona, España
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          "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#41; Radiograf&#237;a convencional de t&#243;rax en proyecci&#243;n posteroanterior donde se visualiza neumomediastino y enfisema subcut&#225;neo &#40;flechas&#41;&#46; B&#41; Reconstrucci&#243;n coronal de la TC de t&#243;rax &#40;ventana de pulm&#243;n&#41; que confirma la presencia de neumomediastino y enfisema subcut&#225;neo &#40;flechas&#41;&#46; C&#41; Imagen axial de la TC de t&#243;rax &#40;ventana de pulm&#243;n&#41; que demuestra la presencia de enfisema peribronquial izquierdo con neumomediastino &#40;flecha&#41;&#44; efecto Macklin&#46; D&#41; Imagen ampliada del enfisema peribronquial &#40;flecha&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Var&#243;n de 27 a&#241;os con antecedentes de asma que acudi&#243; a urgencias en situaci&#243;n de insuficiencia respiratoria aguda&#44; con semiolog&#237;a de broncoespasmo y fiebre de 38&#44;5<span class="elsevierStyleHsp" style=""></span>&#176;C&#46; Se realiz&#243; una radiograf&#237;a de t&#243;rax en la que se visualiz&#243; la presencia de neumomediastino asociado a enfisema subcut&#225;neo &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>A&#41;&#44; sin criterios de drenaje pleural&#46; No se evidenci&#243; focos de condensaci&#243;n neum&#243;nica&#46; Con la orientaci&#243;n diagn&#243;stica de bronquitis aguda&#44; se inici&#243; tratamiento broncodilatador y antibioterapia con amoxicilina-clavul&#225;nico&#46; Aunque se objetiv&#243; una mejor&#237;a parcial&#44; con resoluci&#243;n de la semiolog&#237;a de broncoespasmo&#44; dada la persistencia de requerimientos de oxigenoterapia suplementaria a bajos flujos&#44; se realiz&#243; angio-TC que si bien descart&#243; la existencia de tromboembolismo pulmonar&#44; permiti&#243; observar la presencia de &#225;reas de enfisema peribroncovascular&#44; el denominado &#171;efecto Macklin&#187; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">figs&#46; 1</a>C y D&#41; y mediast&#237;nico&#44; adem&#225;s del anteriormente mencionado enfisema subcut&#225;neo &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>B&#41;&#46; El paciente present&#243; mejor&#237;a cl&#237;nica progresiva con el tratamiento previamente pautado&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">La fisiopatolog&#237;a del neumomediastino espont&#225;neo fue descrita por primera vez en 1937 por Charles Macklin&#44; y se basa en aumentos bruscos de presi&#243;n en la v&#237;a a&#233;rea&#44; que generan la rotura de los tabiques alveolares&#44; con salida de aire a trav&#233;s de las vainas peribroncovasculares&#44; produciendo una imagen caracter&#237;stica de enfisema peribronquial &#40;<a class="elsevierStyleCrossRef" href="#fig0005">figs&#46; 1</a>C y D&#41; y disecci&#243;n del mediastino<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; El tratamiento es conservador&#44; mediante oxigenoterapia&#44; reposo y analgesia&#46;</p></span>"
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Article information
ISSN: 03002896
Original language: Spanish
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