Pneumomediastinum in the COVID-19 era: to drain or not to drain?

Abstract

Pneumomediastinum (PNM) is a rare clinical finding, usually with a benign course, which is managed conservatively in the majority of cases. However, during the COVID-19 pandemic, an increased incidence of PNM has been observed. Several reports of PNM cases in COVID-19 have been reported in the literature and were managed either conservatively or surgically. In this study, we present our institutional experience of COVID-19 associated PNM, propose a management algorithm, and review the current literature. In total, 43 Case Series were identified, including a total of 747 patients, of whom 374/747 (50.1%) were intubated at the time of diagnosis, 168/747 (22.5%) underwent surgical drain insertion at admission, 562/747 (75.2%) received conservative treatment (observation or mechanical ventilation. Inpatient mortality was 51.8% (387/747), while 45.1% of the population recovered and/or was discharged (337/747). In conclusion, with increased incidence of PNM in COVID-19 patients reported in the literature, it is still difficult to assign a true causal relationship between PNM and mortality. We can, however, see that PMN plays an important role in disease prognosis. Due to increased complexity, high mortality, and associated complications, conservative management may not be sufficient, and a surgical approach is needed.

COVID-19-Related Pleural Diseases

“…Several case series have reported variable incidence ranging from 19 51 to 75.5%. 60 The POETIC study reported that 40.3% patients had both PTX and PTM, but their coexistence did not increase mortality. 36 The treatment of patients with PTM and PTX with severe COVID-19 is mainly aimed at managing PTX.…”

“…The authors suggest a subxiphoid drain for progressive PTM, subcutaneous drains for progressive SCE, and chest drains for PTX. 60 As part of their study, they reviewed 43 case series of 747 patients with PTM in COVID-19 and found that 75.2% of these patients were treated with conservative management and 22.5% with surgical treatment including drains. While it is a good attempt in trying to develop a systematic approach to this complex cohort of patients, the small numbers of cases used in this study ( n = 5) precludes definitive conclusions regarding the efficacy of the suggested algorithm and a larger study is warranted to assess prospectively.…”

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

“…The next day she complained of increased chest pain and a moderate degree of dyspnea, which raised the suspicion of a COVID-19-related respiratory complication, including pneumothorax or pneumomediastinum. Since the previous chest X-ray showed no abnormalities, a chest CT scan was recommended in order to identify such findings [ 10 , 11 ]. It showed no direct signs of pulmonary thromboembolism, no pulmonary condensation, and no pleural effusion.…”

COVID-19 induced type 1 diabetes: A systematic review of case reports and series

“…5 The presentation of the disease caused by the virus may also include non-respiratory manifestations such as vomiting, diarrhoea and abdominal pain, with the extent of organ involvement being unpredictable, especially longterm. [6][7][8][9] Recently, published data suggest that SARS-CoV-2 could also potentially contribute to an increase in the incidence of cases of type 1 diabetes mellitus (T1D), one of the most prevalent endocrine diseases in childhood. 10 Indeed in the UK, investigators reported an 80% increase in the number of cases of T1D in children in 2020 compared with previous years, which may suggest an association between COVID-19 infection and T1D presentation.…”