Case Report: Pneumothorax and Pneumomediastinum as Uncommon Complications of COVID-19 Pneumonia—Literature Review

Abstract

As the COVID-19 pandemic progresses, awareness of uncommon presentations of the disease increases. Such is the case with pneumothorax and pneumomediastinum. Recent evidence suggested that these can occur in the context of COVID-19 pneumonia, even in the absence of mechanical ventilation-related barotrauma. We present two patients with COVID-19 pneumonia complicated by pneumomediastinum. The first patient was a 55-year-old woman who developed COVID-19 pneumonia. Her clinical course was complicated by pneumothorax and pneumomediastinum, and, unfortunately, she died 2 days following the admission. The second patient was a 31-year-old man who developed a small pneumomediastinum and was managed conservatively. He had a spontaneous resolution of the pneumomediastinum and was discharged 19 days later. None of our patients required invasive or noninvasive positive pressure ventilation. We performed a literature review of COVID-19 pneumonia cases that developed pneumothorax, pneumomediastinum, or both. The analysis showed that the latter had high mortality (60%). Thus, it is necessary to pay attention to these complications as early identification and management can reduce the associated morbidity and mortality.

Development of a large spontaneous pneumothorax after recovery from mild COVID-19 infection

“… 21 In a review of 20 case reports of COVID-19 patients with pneumothorax, a male preponderance of 88.8% was observed. 22 This is consistent with the gender distribution in non-COVID-19 associated spontaneous pneumothorax patients. 23 What becomes clear from reviewing these reported cases is that most of these patients were quite ill from COVID-19, many required ICU care, most developed a pneumothorax during their hospitalisation, though some presented with a pneumothorax at the same time that they had symptomatic COVID-19 infection.…”

COVID-19 in Patients With Hematologic-Oncologic Risk Factors: Complications in Three Patients

“…Our second patient demonstrated a case of spontaneous pneumomediastinum, another unusual complication of COVID-19. There has been a growing number of case reports of spontaneous pneumomediastinum associated with COVID-19 pneumonia with the exact mechanism not well understood [ 12 ]. Increased alveolar pressure and diffuse alveolar injury in severe COVID-19 pneumonia is common and may make alveoli more prone to rupturing during the increased airway pressures of coughing [ 12 ].…”

“…There has been a growing number of case reports of spontaneous pneumomediastinum associated with COVID-19 pneumonia with the exact mechanism not well understood [ 12 ]. Increased alveolar pressure and diffuse alveolar injury in severe COVID-19 pneumonia is common and may make alveoli more prone to rupturing during the increased airway pressures of coughing [ 12 ]. Many cases of spontaneous pneumomediastinum in the setting of non-mechanical ventilation have also been complicated by pneumothorax [ 13 , 14 ].…”

A case of secondary tension pneumothorax in COVID-19 pneumonia in a patient with no prior history of lung disease

“…Thus, he did not have the aforementioned predisposing factors for development of a tension pneumothorax. Although there have been several case reports highlighting the occurrence of spontaneous pneumothorax or pneumomediastinum in patients with COVID-19 pneumonia, 10 there have been only four prior case reports of patients with COVID-19 pneumonia who developed a tension pneumothorax. Yasukawa et al 7 described a tension pneumothorax in a patient with no significant past medical history who was admitted with COVID-19 infection.…”