Case Report

The Earth-Heart sign: a new diagnostic finding in a patient with tension pneumomediastinum

This is known as the Macklin effect, first described by Macklin in 1939 and further characterized with computed tomography scans in more modern case series.3-5 Several methods of decompression for tension pneumomediastinum have been described, including transverse cervicotomy with Penrose drain placement, placement of bilateral chest tubes, repeated fluoroscopic-guided percutaneous pneumomediastinal decompressions, and thoracoscopic mediastinotomy.6-8 Given the respiratory and hemodynamic instability of our patient, as well as the concern for coronavirus aerosolization, bedside mediastinotomy in the intensive care unit with negative pressure capabilities was performed.