Pneumomediastinum in a child with severe COVID-19

Abstract

The current global pandemic of the novel coronavirus SARS-CoV2 is a threat to the health and lives of millions of people worldwide. The latest statistics from the World Health Organisation show that there have been 6,515,796 confirmed cases worldwide with 387,298 confirmed deaths (last update fifth June 2020, 10:41 CEST). The majority of critically unwell patients with SARS-CoV2 are adults and the radiological findings associated with them are consistent throughout the literature. However, the reported paediatric cases are few, and as such, there is a limited body of evidence available. More international data is needed, not only on the clinical presentation, but also the radiological findings, so that healthcare providers are better able to understand and diagnose this pandemic disease. We describe a case of a previously healthy nine-year-old female who presented to the Emergency Department with symptoms suggestive of raised intracranial pressure. Her Computed Tomography (CT) revealed a medulloblastoma and post-operatively she tested positive for SARS-CoV2. She had a rapid deterioration in her clinical condition and required admission to the intensive care unit (ICU). We provide the supporting radiology along her clinical course in order to demonstrate important insights into this disease in children, including the unusual pnemomediastinum complications which occurred as part of her clinical course. This case is the first reported of its kind.

COVID‐19 presenting with spontaneous massive pneumomediastinum in a three‐month‐old child

“…However, pneumomediastinum is becoming an increasingly recognised, though still rare, complication of COVID‐19. In the adult population, there are now multiple published case series of pneumomediastinum and subcutaneous emphysema in self‐ventilating adults with COVID‐19 [ 3 , 4 , 5 ]. In the paediatric population, a small body of literature exists on pneumomediastinum and subcutaneous emphysema in self‐ventilating children with other viral illnesses, the proposed mechanism being a Valsalva manoeuvre associated with excessive coughing [ 8 ].…”

“…Pneumomediastinum has been described as a rare but increasingly reported complication of COVID‐19 in adults, particularly in the context of positive pressure ventilation [ 3 ]. Pneumomediastinum has been reported in a nine‐year‐old child with SARS‐CoV‐2 after several days of mechanical ventilation following emergency neurosurgery [ 4 ]. The precise mechanism of spontaneous pneumomediastinum in COVID‐19 is unknown but its occurrence may be an indicator of worsening or severe disease [ 5 ].…”

Spontaneous Massive Pneumomediastinum in a Previously Well Infant With COVID-19

“…The occurrence of a spontaneous pneumomediastinum associated with Covid-19 in a previously well infant has not been documented. There are three other cases of pneumomediastinum reported in children with Covid-19 as of March 2021 (Table 1); one case the pneumomediastinum/pneumothorax were attributed to a transbronchial biopsy (13); the second case reported a 9 year old who developed Covid-19 and a pneumomediastinum post-craniectomy but high ventilatory pressures intra-operatively may have contributed to barotrauma (14); the third case reported a spontaneous pneumomediastinum in a 17-year-old male with Covid-19. The mechanisms proposed were possible lung inflammation and 2 weeks of cough resulting in barotrauma (15).…”

Spontaneous Pneumomediastinum in a 16-Year-Old Patient with SARS-CoV-2 Infection: A North-East Romanian Case

“…Many patients, especially adults, experienced severe respiratory symptoms and complications, including atypical pneumonia, acute respiratory distress syndrome (ARDS), and respiratory compromise, which required ICU admissions and mechanical ventilation. A small number of patients developed several types of rare respiratory manifestations, including spontaneous pneumomediastinum (SPM) [ 1 , 2 ].…”

“…It is defined by the presence of air in the mediastinum not related to trauma or iatrogenic procedure, such as endotracheal intubation or assisted mechanical ventilation. The etiology is considered to be diffuse alveolar damage and air leak through alveolar ruptures into the surrounding broncho vascular sheath-Macklin phenomenon [ 1 , 2 , 3 , 4 ]. Less commonly, pneumomediastinum can occur from air coming out of the upper respiratory tract, the intrathoracic airways, or the gastrointestinal tract secondary to increased intraluminal pressure or disturbed wall integrity [ 5 ].…”