Spontaneous Air-leak Syndrome and COVID-19: A Multifaceted Challenge

Abstract

Spontaneous air-leak syndromes have emerged as rare but significant complication of Coronavirus disease-2019 (COVID-19) pneumonia in the last few months. This complication has been documented in both spontaneous and mechanically ventilated patients. Although few studies have used computed tomographic scans to confirm the diagnosis, this could be challenging in resource-limited setup. We present a series of 15 cases that highlight the clinical heterogeneity with respect to stage of illness, ventilatory status, and varied clinical scenarios at the time of development of these syndromes. All cases in our series were diagnosed clinically and confirmed by bedside chest X-ray and were managed promptly. Though mortality was not so infrequent in our experience, these air-leak syndromes were not directly attributed as cause of death in these patients. Therefore, high level of clinical suspicion and vigilance is necessary to identify and manage cases of air-leak syndrome. How to cite this article: Sabharwal P, Chakraborty S, Tyagi N, Kumar R, Taneja A. Spontaneous Air-leak Syndrome and COVID-19: A Multifaceted Challenge. Indian J Crit Care Med 2021;25(5):584-587.

Keywords: Air-leak syndrome; COVID-19; Pneumomediastinum; Pneumothorax; Subcutaneous emphysema.

Figs 1A to C

(A) Subcutaneous emphysema, pneumomediastinum, subpleural blebs, ground-glass opacities; (B) Ground-glass opacities only; (C)Subcutaneous emphysema, pneumomediastinum, subpleural blebs, ground-glass opacities, crazy paving, reverse halo sign

Figs 2A and B

Subcutaneous emphysema and thin rim of mediastinal air