Coronavirus disease 2019 (COVID-19) complicated by Spontaneous Pneumomediastinum and Pneumothorax

Gillespie, Megan; Dincher, Nathan; Okorji, Onyinyechukwu; Finkle, Jacob; Can, Argun

doi:10.1016/j.rmcr.2020.101232

Cited by 10 publications

(7 citation statements)

References 15 publications

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“…The risk of development of SPM in COVID-19 patients has been associated with mechanical and non-invasive ventilation [ 16 , 17 , 18 ]. In addition, similarly to our patients 2 and 3, there are some reported cases of SPM in COVID-19 patients managed with HFNC [ 3 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ], whose contribution to the occurrence of SPM is still unclear. The aforesaid observations may confound the role that COVID-19 plays in the development of SPM.…”

Section: Discussionsupporting

confidence: 81%

Spontaneous pneumomediastinum and COVID-19 pneumonia: Report of three cases with emphasis on CT imaging

Kalpaxi

Kalokairinou

Katseli

et al. 2021

Radiology Case Reports

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Spontaneous pneumomediastinum (SPM) is a rare complication of coronavirus disease 2019 (COVID-19). The published literature consists mainly of case reports and small case series. There are still many questions regarding the pathogenesis, the prognostic significance and the implications on patient management. In our hospital three COVID-19 patients developed SPM: one on admission at the emergency department and the other two during hospitalization. In this study we describe their clinical course and computed tomography (CT) findings. All of them had severe disease according to the total severity score on admission CT. The management of pneumomediastinum was conservative and follow-up CT showed resolution in all patients. As the correlation between extension of parenchymal lung lesions and development of pneumomediastinum is still under investigation, we highlight the importance of reporting the severity score on chest CT in order to obtain more comparable results between different studies. Furthermore, in this tragic circumstance we also had the opportunity to familiarize ourselves with the otherwise uncommon occurrence of air along the bronchovascular sheaths (Macklin effect) and evaluate the ability of CT to detect it.

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Section: Discussionsupporting

confidence: 81%

Spontaneous pneumomediastinum and COVID-19 pneumonia: Report of three cases with emphasis on CT imaging

Kalpaxi

Kalokairinou

Katseli

et al. 2021

Radiology Case Reports

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“…Prone position for 18 hrs./day and on day 9 venovenous extracorporeal membrane oxygenation Died (Day 15) 47 Male Drug and alcohol abuse SOB Fever On day 3 chest X-ray: right subcutaneous emphysema and pneumomediastinum On day 8, the patient had a right spontaneous apical pneumothorax SpO2=75%, elevated ferritin CRP D-Dimer LDH Oxygen, followed by intubation due to desaturation, HCQ, Antibiotic, Zinc, prone position for 18 hrs/day, and tocilizumab. Chest tube was placed to treat pneumothorax Improved and moved to the floor 78 Male Dyslipidemia HTN SOB Confusion Chest X-ray on day 5: subcutaneous emphysema and pneumomediastinum, which were not seen on the chest X-rays were taken on day 1 and 3 Hemodynamically unstable, SpO2=88% HCQ, Antibiotic, Zinc, Vitamin C, vasopressors due to hypotension Died Nina Goldman 30 22 May 2020 64 Male DM2 OSA previous COVID (3 weeks ago) Chest pain Tachycardia Chest X-ray: GGO both lungs CTA: pneumomediastinum, consolidation consistent with COVID-19 None No therapy needed Recovered (24 hrs) Megan Gillespie 31 23 Sept 2020 70 Male Hyperlipidemia, HTN Chills, Cough SOB Chest pain, loss of taste Dizziness Chest X-ray: normal Chest X-ray on day 7: spontaneous pneumomediastinum, subcutaneous emphysema, and bilateral patchy airspace disease Chest CT: extensive pneumomediastinum, bilateral GGO Chest CTA: extensive GGO, pneumomediastinum, subcutaneous emphysema in the neck, and a new finding of a small right pneumothorax SpO2=89%, RT-PCR COVID + hyponatremia, elevated AST, LDH, CRP, ferritin D-Dimer Oxygen, HCQ, Steroids, heparin, and later after CTA patient was intubated The family decided to extubate the patient. Carlo Urigo 32 3 Oct 2020 54 Male HTN DM Cough SOB Chest x-ray: bilateral airspace opacification in a subpleural and basal distribution, subcutaneous emphysema Chest CT: subcutaneous emphysema and gas locules were noted adjacent to the anterior aspect of the right heart border.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Pneumomediastinum in Patients Diagnosed with COVID-19: A Case Series with Review of Literature

et al. 2021

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Spontaneous pneumomediastinum is a rare condition defined by the presence of air in the mediastinum in the absence of traumatic or iatrogenic. Although the imaging findings and complications of SARS-CoV-2 infection have been reported many times, there are few reports of the prevalence and outcomes of patients with spontaneous pneumomediastinum. In this paper, we aimed to illustrate the different manifestations, management, and outcome of three cases of SPM in COVID-19 patients and provide an extensive review of 22 related published case reports and series of 35 patients. Statistical analysis of the reviewed articles showed that SPM in COVID-19 occurs in patients with a mean age of 55.6 ± 16.7 years. Furthermore, 80% of the 35 patients are males and almost 60% have comorbidities. Intriguingly, SPM in COVID-19 is associated with a 28.5% mortality rate. These findings are consistent with our case series and are different from previous reports of SPM in non-COVID-19 cases where it most commonly occurs in younger individuals and has a self-limiting course with a good outcome. Therefore, SPM in COVID-19 patients occurs in older patients and is potentially associated with a higher mortality rate. Further studies are necessary to assess its role as a prognostic marker of poor outcome.

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“…1 ). Articles and case descriptions with as much information as possible were selected for analysis; therefore, not all case studies were selected [ [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] ...…”

Section: Methodsmentioning

confidence: 99%

Pneumothorax due to COVID-19: Analysis of case reports

Gaytán¹,

Andrade²,

Valenzo³

2021

Respiratory Medicine Case Reports

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Cases of pneumothorax/pneumomediastinum have been reported in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); however, the time to onset and hospital stay have rarely been studied. Coronavirus disease 2019 (COVID-19) patients with these complications are described to determine the time to onset, associated comorbidities, and location and duration of pneumothorax. A search in PubMed yielded simple frequencies and a bivariate analysis of deaths. There were 113 confirmed cases in 67 articles. The median time from the date of hospital admission to the presence of pneumothorax was 8 days. Right hemithorax was the most frequent form of pneumothorax. Almost half of the patients required intubation for invasive mechanical ventilation. Although the frequency of this phenomenon was not high among hospitalized patients with confirmed SARS-CoV-2, it was high among those who developed acute respiratory distress syndrome (ARDS). This study contributes to the literature because it presents a large number of patients who developed pneumothorax after admission, which was characterized by clinical deterioration (dyspnea, tachypnea, pleuritic chest pain, and subcutaneous emphysema) and low oxygen saturation levels. Pneumothorax/pneumomediastinum is recommended as a differential diagnosis, even without considering the presence of chronic pulmonary comorbidities or invasive mechanical ventilation.

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Coronavirus disease 2019 (COVID-19) complicated by Spontaneous Pneumomediastinum and Pneumothorax

Cited by 10 publications

References 15 publications

Spontaneous pneumomediastinum and COVID-19 pneumonia: Report of three cases with emphasis on CT imaging

Spontaneous pneumomediastinum and COVID-19 pneumonia: Report of three cases with emphasis on CT imaging

Spontaneous Pneumomediastinum in Patients Diagnosed with COVID-19: A Case Series with Review of Literature

Pneumothorax due to COVID-19: Analysis of case reports

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