Alveolar air leakage in COVID-19 patients: Pneumomediastinum and/or pneumopericardium

Hamad, Abdel-Mohsen; Elmahrouk, Ahmed F.; Abdulatty, Osama A.

doi:10.1016/j.hrtlng.2020.09.006

Cited by 21 publications

(34 citation statements)

References 10 publications

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“…On the contrary, after the second outbreak of the pandemic, since 1 October 2020 until the end of January 2021, of all 1648 patients admitted in the hospital, we observed the occurrence of these complications in 11 subjects, leading to a prevalence of 0.66%, similar to around 1% reported for hospitalized patients in the medical literature [ 3 , 11 , 12 , 13 ]. As in the other studies, the male gender prevailed (72.72%), and the supposed pathophysiological mechanisms were air leakage through the alveolar walls, damage by inflammation, and damage by the subsequent cytokine storm [ 1 , 2 , 5 , 14 ]. In our patients, all these complications occurred spontaneously, after several days of evolution, often coinciding with the aggravation of pulmonary lesions, but in the absence of invasive mechanical ventilation or non-invasive positive pressure ventilation.…”

Section: Discussionmentioning

confidence: 56%

“…COVID-19 has become the largest pandemic in recent centuries and is associated with increased morbidity and mortality, as well as a large spectrum of complications. Several articles, published in the medical literature worldwide [ 1 , 2 , 3 , 4 ], debate sporadic cases of spontaneous pneumomediastinum (PM), pneumothorax (PT), pneumopericardium (PP), and subcutaneous emphysema (SE) diagnosed in patients with SARS-CoV2 pneumonia, even in the absence of mechanical ventilation associated with barotrauma. Subsequently, several retrospective studies [ 4 , 5 ], the largest one being a multicenter analysis of Martinelli et al [ 3 ], focused on this topic.…”

Section: Introductionmentioning

confidence: 99%

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Spontaneous Pneumomediastinum, Pneumothorax, Pneumopericardium and Subcutaneous Emphysema—Not So Uncommon Complications in Patients with COVID-19 Pulmonary Infection—A Series of Cases

Cuț

Tudoran

Lăzureanu

et al. 2021

JCM

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(1) Background: Spontaneous pneumomediastinum (PM), pneumothorax (PT), and pneumopericardium (PP) were recently reported as rare complications in patients with severe COVID-19 pneumonia, and our study aims to follow the evolution of these involvements in 11 cases. The presumed pathophysiological mechanism is air leak due to extensive diffuse alveolar damage followed by alveolar rupture. (2) Methods: We followed the occurrence of PM, PN, PP, and subcutaneous emphysema (SE) in 1648 patients hospitalized during the second outbreak of COVID-19 (October 2020–January 2021) in the main hospital of infectious diseases of our county and recorded their demographic data, laboratory investigations and clinical evolution. (3) Results: Eleven patients (0.66%) developed PM, with eight of them having associated PT, one PP, and seven SE, in the absence of mechanical ventilation. Eight patients (72.72%) died and only three (27.27%) survived. All subjects were nonsmokers, without known pulmonary pathology or risk factors for such complications. (4) Conclusions: pneumomediastinum, pneumothorax, and pneumopericardium are not so uncommon complications of SARS-CoV2 pneumonia, being observed mostly in male patients with severe forms and associated with prolonged hospitalization and poor prognosis. In some cases, with mild forms and reduced pulmonary injury, the outcome is favorable, not requiring surgical procedures, mechanical ventilation, or intensive care stay.

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Section: Discussionmentioning

confidence: 56%

Section: Introductionmentioning

confidence: 99%

Spontaneous Pneumomediastinum, Pneumothorax, Pneumopericardium and Subcutaneous Emphysema—Not So Uncommon Complications in Patients with COVID-19 Pulmonary Infection—A Series of Cases

Cuț

Tudoran

Lăzureanu

et al. 2021

JCM

View full text Add to dashboard Cite

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“…Wali et al 17 managed patients aggressively by placing chest drains, whereas Volpi et al 18 successfully managed two patients of PM by conservative approach. Hamad et al 19 suggested inserting a unilateral intrapleural chest drain to protect at least one side against potential pneumothorax. All three patients in our series were managed conservatively – one patient recovered, and the other two patients died due to multi-organ failure.…”

Section: Discussionmentioning

confidence: 99%

Pneumomediastinum in COVID-19: A series of three cases and review of literature

Machiraju

Alex

Safinaaz

et al. 2021

SAGE Open Medical Case Reports

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Coronavirus disease-19 caused by severe acute respiratory syndrome Corona virus-2 is characterised by wide heterogeneity in clinical presentation. The typical radiographic findings in COVID-19 include bilateral ground-glass opacities and/or consolidations predominantly affecting the lower lobes and posterior segments of lungs. Other rare abnormal radiographic findings include pneumothorax, pneumomediastinum and pneumopericardium. There has been an increased incidence of pneumomediastinum, a rare but potentially life-threatening complication during this pandemic. It may be spontaneous or secondary. Pneumomediastinum may be due to barotrauma, cytokine storm induced diffuse alveolar injury or direct viral infection of type I and type II pneumocytes. The presence of pneumomediastinum in COVID-19 patients may indicate extensive alveolar membrane destruction and those patients need close monitoring. There are no consensus guidelines in managing COVID-19 patients with pneumomediastinum. Higher mortality rates (70.58%) are reported in intubated COVID-19 patients with pneumomediastinum. The development of pneumomediastinum in COVID-19 should be considered as a poor prognostic factor.

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“…It has been found that SARS-CoV-2 attaches to the respiratory epithelium and attacks the alveolar cells by entering through angiotensin converting enzyme 2 (ACE2) receptors, this in combination with cytokine storm make the alveoli vulnerable to rupture, resulting in air leakage and the development of cystic air space lesions, and cause lung cystic abnormalities in up to 10% of the patients [ 13 , 14 ]. When SARS-CoV-2 infection starts, pleural effusion can occur with varying incidence.…”

Section: Discussionmentioning

confidence: 99%