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. 2021 Mar 24;10(7):1346.
doi: 10.3390/jcm10071346.

Spontaneous Pneumomediastinum, Pneumothorax, Pneumopericardium and Subcutaneous Emphysema-Not So Uncommon Complications in Patients with COVID-19 Pulmonary Infection-A Series of Cases

Talida Georgiana Cut  1 , Cristina Tudoran  2   3   4 , Voichita Elena Lazureanu  1 , Adelina Raluca Marinescu  1 , Raluca Dumache  5 , Mariana Tudoran  2   3   4
Affiliations

Spontaneous Pneumomediastinum, Pneumothorax, Pneumopericardium and Subcutaneous Emphysema-Not So Uncommon Complications in Patients with COVID-19 Pulmonary Infection-A Series of Cases

Talida Georgiana Cut et al. J Clin Med. .

Abstract

(1) Background: Spontaneous pneumomediastinum (PM), pneumothorax (PT), and pneumopericardium (PP) were recently reported as rare complications in patients with severe COVID-19 pneumonia, and our study aims to follow the evolution of these involvements in 11 cases. The presumed pathophysiological mechanism is air leak due to extensive diffuse alveolar damage followed by alveolar rupture. (2) Methods: We followed the occurrence of PM, PN, PP, and subcutaneous emphysema (SE) in 1648 patients hospitalized during the second outbreak of COVID-19 (October 2020-January 2021) in the main hospital of infectious diseases of our county and recorded their demographic data, laboratory investigations and clinical evolution. (3) Results: Eleven patients (0.66%) developed PM, with eight of them having associated PT, one PP, and seven SE, in the absence of mechanical ventilation. Eight patients (72.72%) died and only three (27.27%) survived. All subjects were nonsmokers, without known pulmonary pathology or risk factors for such complications. (4) Conclusions: pneumomediastinum, pneumothorax, and pneumopericardium are not so uncommon complications of SARS-CoV2 pneumonia, being observed mostly in male patients with severe forms and associated with prolonged hospitalization and poor prognosis. In some cases, with mild forms and reduced pulmonary injury, the outcome is favorable, not requiring surgical procedures, mechanical ventilation, or intensive care stay.

Keywords: COVID-19; cytokine storm; inflammation; pneumopericardium; pneumothorax; spontaneous pneumomediastinum; subcutaneous emphysema.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Case 1–patient admitted with moderate COVID-19 injury, developed PT and subsequently PM. Legend: PT-pneumothorax—green arrow; PM-pneumomediastinum—orange arrow; (a) initial CT with moderate injury; (b) right PT; (c) control CT after surgical drainage of PT; (d) PM and severe pulmonary injury.
Figure 2
Figure 2
Case 2-Pneumomediastinum and subcutaneous emphysema. Legend: PM—pneumomediastinum—orange arrow; SE—subcutaneous emphysema—blue arrow.
Figure 3
Figure 3
Case 3: Pneumomediastinum, pneumopericardium, and subcutaneous emphysema. Legend: PM—pneumomediastinum—orange arrow; PP—pneumopericardium—magenta arrow; SE—subcutaneous emphysema—blue arrow.
See this image and copyright information in PMC

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