Pneumomediastinum in COVID-19: A series of three cases and review of literature

Abstract

Coronavirus disease-19 caused by severe acute respiratory syndrome Corona virus-2 is characterised by wide heterogeneity in clinical presentation. The typical radiographic findings in COVID-19 include bilateral ground-glass opacities and/or consolidations predominantly affecting the lower lobes and posterior segments of lungs. Other rare abnormal radiographic findings include pneumothorax, pneumomediastinum and pneumopericardium. There has been an increased incidence of pneumomediastinum, a rare but potentially life-threatening complication during this pandemic. It may be spontaneous or secondary. Pneumomediastinum may be due to barotrauma, cytokine storm induced diffuse alveolar injury or direct viral infection of type I and type II pneumocytes. The presence of pneumomediastinum in COVID-19 patients may indicate extensive alveolar membrane destruction and those patients need close monitoring. There are no consensus guidelines in managing COVID-19 patients with pneumomediastinum. Higher mortality rates (70.58%) are reported in intubated COVID-19 patients with pneumomediastinum. The development of pneumomediastinum in COVID-19 should be considered as a poor prognostic factor.

Keywords: COVID-19; Pneumomediastinum; SARS CoV-2; pneumopericardium.

Figure 1.

CT-scan chest of patient 1 showing pneumomediastinum.

Figure 2.

Chest X-ray of patient 1 showing features of ARDS, subcutaneous emphysema and resolving pneumomediastinum.

Figure 3.

CT chest of second patient showing pneumomediastinum with pneumopericardium.

Figure 4.

CT chest of second patient showing pneumomediastinum with pneumopericardium.

Figure 5.

Chest X-ray of second patient showing features of ARDS, and resolving pneumopericardium and pneumomediastinum.

Figure 6.

CT chest of third patient showing pneumomediastinum.

Figure 7.

Chest X-ray of third patient showing resolution of pneumomediastinum.