Pneumomediastinum and spontaneous pneumothorax as an extrapulmonary complication of COVID-19 disease

Abstract

The new disease outbreak that causes atypical pneumonia named COVID-19, which started in China's Wuhan province, has quickly spread to a pandemic. Although the imaging test of choice for the initial study is plain chest radiograph, CT has proven useful in characterizing better the complications associated with this new infection. We describe the evolution of 3 patients presenting pneumomediastinum and spontaneous pneumothorax as a very rare complication of COVID-19 and their particular interest as a probable prognostic factor.

Keywords: COVID-19; Complications; Pneumomediastinum; Pneumothorax.

Fig. 1

a Axial slide in lung window, evidence of a bilateral pneumothorax chamber (green arrows), and pneumomediastinum (red arrows). b Coronal MPR reconstruction in lung window, with the right pneumothorax chamber, as well as the presence of air in the mediastinum in the ascending thoracic aorta and surrounding the cardiac silhouette. Observe the GGO (ground-glass opacities) in the visible lung parenchyma typical of COVID-19 involvement

Fig. 2

Radiograph in PA (a) and lateral (b) projection of the chest with diffuse and multilobar parenchymal involvement, presenting with bilateral alveolo-interstitial opacities and subpleural consolidation in the right upper lobe, bilateral apical pneumothorax (green), and pneumomediastinum (red)

Fig. 3

Coronal reconstruction in the lung window (image a), a chamber of bilateral apical partial pneumothorax (red), pneumomediastinum surrounding the great vessels, and cardiac silhouette (green) and pneumorachis (black arrow) were identified. Axial section of CT of the chest (image b), with extensive lung affectation of ground-glass attenuation and thickening of septa (crazy paving), predominantly bibasal

Fig. 4

Chest CT scan with iodinated contrast to study the pulmonary arteries. Coronal reconstruction (image a) after maximum intensity projection post-processing (MIP), where filling defects are observed in the segmental branches of the superior lobar arteries (white). Sagittal MPR reconstruction (image b) and a minimal pneumomediastinum chamber is identified (blue arrow). Axial CT slice (image c), with extensive bilateral parenchymal involvement showing areas of ground-glass opacities and bibasal consolidation (stars)