Spontaneous Pneumothorax With Subcutaneous Emphysema: A Rare Complication of Respiratory Syncytial Virus Infection

Silva, Cármen; Almeida, Ana Filipe; Ferraz, Catarina; Nunes, Teresa; Vaz, Luísa Guedes

doi:10.14740/jocmr2353w

Cited by 10 publications

(13 citation statements)

References 14 publications

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“…SPM unrelated to intubation or positive pressure ventilation has been previously reported in respiratory infections such as pneumocystis pneumonia (PCP), Staphylococcus aureus pneumonia, cytomegalovirus (CMV), influenza bronchiolitis, and even severe acute respiratory syndrome (SARS) [ 12 , 24 , 25 ]. Additional predisposing factors have been observed such as asthma, corticosteroids, respiratory irritants, and other anatomical abnormalities such as tracheomalacia [ [26] , [27] , [28] , [29] ].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous subcutaneous emphysema and pneumomediastinum in non-intubated patients with COVID-19

et al. 2020

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Purpose We describe the presenting characteristics and hospital course of 11 novel coronavirus (COVID-19) patients who developed spontaneous subcutaneous emphysema (SE) with or without pneumomediastinum (SPM) in the absence of prior mechanical ventilation. Materials and methods A total of 11 non-intubated COVID-19 patients (8 male and 3 female, median age 61 years) developed SE and SPM between March 15 and April 30, 2020 at a multi-center urban health system in New York City. Demographics (age, gender, smoking status, comorbid conditions, and body-mass index), clinical variables (temperature, oxygen saturation, and symptoms), and laboratory values (white blood cell count, C-reactive protein, D-dimer, and peak interleukin-6) were collected. Chest radiography (CXR) and computed tomography (CT) were analyzed for SE, SPM, and pneumothorax by a board-certified cardiothoracic-fellowship trained radiologist. Results Eleven non-intubated patients developed SE, 36% (4/11) of whom had SE on their initial CXR. Concomitant SPM was apparent in 91% (10/11) of patients, and 45% (5/11) also developed pneumothorax. Patients developed SE on average 13.3 days (SD: 6.3) following symptom onset. No patients reported a history of smoking. The most common comorbidities included hypertension (6/11), diabetes mellitus (5/11), asthma (3/11), dyslipidemia (3/11), and renal disease (2/11). Four (36%) patients expired during hospitalization. Conclusion SE and SPM were observed in a cohort of 11 non-intubated COVID-19 patients without any known cause or history of invasive ventilation. Further investigation is required to elucidate the underlying mechanism in this patient population.

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Section: Discussionmentioning

confidence: 99%

Spontaneous subcutaneous emphysema and pneumomediastinum in non-intubated patients with COVID-19

et al. 2020

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“…Our study confirmed that one third of our patients was exposed to cigarette smoke by family members, but since this condition suggests that cigarette smoke cannot be a parameter in SP development on its own, studies with much larger populations are needed to evaluate statistical significance. Similarly, even though life in a crowded habitat and contact with an individual with URTI are risk factors for bronchiolitis/viral pneumonia, their relation with SP is not known (13). We detected that two thirds of our patients came in contact with family members with URTI but their URTI agents was not known and clear evidence could not be provided for us.…”

Section: Discussionmentioning

confidence: 70%

Evaluation of Patients with Spontaneous Pneumothorax Secondary to Viral Pneumonia in Pediatric Intensive Care in 2018

Ceylan¹,

Azapağası²,

Yazıcı³

et al. 2019

J Pediatr Inf

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Bu yazıda 2018 yılında merkezimize başvuran ve çocuk yoğun bakım yatışı gerektiren viral pnömoniye bağlı spontan pnömotorakslı olguların klinik değerlendirilmesi yapılarak bu nadir durumun izleminde literatüre katkıda bulunması amaçlanmıştır. Gereç ve Yöntemler: Çalışmada Ocak 2018-Aralık 2018 tarihleri arasında hastanemiz çocuk yoğun bakım ünitesinde viral pnömoniye bağlı spontan pnömotoraks gelişen hastalar geriye dönük olarak incelendi. Tüm hastaların başvuru yaşı, cinsiyet, sigara içen bireyle teması, üst solunum yolları enfeksiyonu teması, pnömoni etkeni, pnömotoraks zamanı, pnömotoraksa yönelik verilen tedavi, invaziv veya noninvaziv mekanik ventilasyonda kalma süresi, yoğun bakım yatış süresi ve taburculuk anındaki klinik durumları kaydedildi. Bulgular: Ocak 2018-Aralık 2018 tarihleri arasında çocuk yoğun bakım ünitesine yatırılan 652 hastanın 230'unun pnömoni nedeniyle yatırıldığı ve bunların %3'ünde viral pnömoniye bağlı spontan pnömotoraks geliştiği tespit edildi. Yaş dağılımı 42 gün ile 28 ay arasındaydı. Pnömoni etkenleri olarak respiratuvar sinsityal virüs influenza A, rinovirüs ve rinovirüs ile Pseudomonas aeruginosa saptandı. Beş hastaya tüp torakostomi takılırken, diğer hastalar %100 oksijen desteği ile izlendi. Üç hastada invaziv mekanik ventilasyon ihtiyacı oldu. Bir hasta altta yatan yağ asiti oksidasyon defekti nedeniyle eksitus olurken, diğer yedi hastada tam iyileşme gözlendi.

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“…Clinically, SE is characterized by swallowing and crackling during skin palpation. In a case report, SE has been described as consequence of pneumothorax in respiratory syncytial virus bronchiolitis [14].…”

Section: Journal Of Intensive and Critical Care Issn 2471-8505mentioning

confidence: 99%

“…The necessity of invasive treatments (incision and drainage or chest surgery approaches) is reserved to severe patients with, for example, tension pneumomediastinum [1,14,15].…”

Section: Journal Of Intensive and Critical Care Issn 2471-8505mentioning

confidence: 99%

Subcutaneous Emphysema and Pneumomediastinum in 2 Years Old Children with Pierre Robin Syndrome: Multi-Disciplinary Management in an Emergency Department

Porta¹,

Ghiselli²,

Mevio³

et al. 2017

Intensive & Crit Care

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Spontaneous pneumomediastinum (SPM) is an uncommon disease defined by the presence of free air in the mediastinal cavity. Its pathogenesis is characterized by all the processes that cause a sudden increase of intrathoracic pressure. Triggering factors are: lower airway infections, asthma, esophageal rupture, foreign body aspiration and diabetic ketoacidosis. When a cause is not found, SPM is defined idiopathic. The abnormal presence of air in mediastinum can cause subcutaneous emphysema (SE) in the neck and upper part of the thorax. The aim of this report was to describe a patient with an underlying genetic disorder (Pierre Robin syndrome) and SPM with consequent SE. A multidisciplinary approach in our Accident and Emergency department was important for the right management.

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Spontaneous Pneumothorax With Subcutaneous Emphysema: A Rare Complication of Respiratory Syncytial Virus Infection

Cited by 10 publications

References 14 publications

Spontaneous subcutaneous emphysema and pneumomediastinum in non-intubated patients with COVID-19

Spontaneous subcutaneous emphysema and pneumomediastinum in non-intubated patients with COVID-19

Evaluation of Patients with Spontaneous Pneumothorax Secondary to Viral Pneumonia in Pediatric Intensive Care in 2018

Subcutaneous Emphysema and Pneumomediastinum in 2 Years Old Children with Pierre Robin Syndrome: Multi-Disciplinary Management in an Emergency Department

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