Spontaneous Pneumomediastinum/Pneumothorax in Patients With COVID-19

Abstract

No spontaneous air leak case series have been described in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patient population thus far. We described seven spontaneous air leak cases we found in our coronavirus disease 2019 (COVID-19) positive 976-patient cohort. Five out of seven patients eventually required mechanical ventilation, and one of these patients died. All of our patients who demonstrated radiological air leaks after intubation died. No other precipitating factors offered in the literature thus far played a role in our patient population. We presume that acute lung injury leading to SARS-CoV-2 with associated acute respiratory distress syndrome (ARDS) predisposes patients to this rare complication.

Keywords: covid-19; mechanical ventilation; pneumomediastinum; pneumothorax.

Figure 1. Computed tomography (CT) of the chest for patient 1 and patient 5 showing initial and follow-up imaging

1A - CT chest with pneumomediastinum extending into the subcutaneous emphysema in the neck and bilateral ground glass opacifications, 1B - CT chest showing resolution of the air leak, 5A - CT chest with pneumomediastinum tracking into the neck, 5B - CT chest post-intubation with severe worsening of the air leak