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Case Reports
. 2021 Sep 4;13(9):e17715.
doi: 10.7759/cureus.17715. eCollection 2021 Sep.

COVID-19-Associated Pneumomediastinum and Pneumothorax: A Case Series

Ankita Kabi  1 , Nidhi Kaeley  1 , Takshak Shankar  1 , Shrirang Joshi  1 , Pradeep Kumar Roul  2
Affiliations
Case Reports

COVID-19-Associated Pneumomediastinum and Pneumothorax: A Case Series

Ankita Kabi et al. Cureus. .

Abstract

Coronavirus disease-19 (COVID-19) causes mild to moderate illness in most patients but in some cases a severe illness may manifest. Such patients usually present with hypoxaemic respiratory failure due to acute lung injury caused by a viral infection and host-mediated cytokine storm. The characteristic radiographic findings are ground-glass opacities with consolidation in posterior basal areas of bilateral lungs and rarely pneumothorax (PTX) and pneumomediastinum (PM). The incidence of these findings was notably higher in the second wave of the pandemic in India in 2021 as compared to the first wave in 2020. The etiopathogenesis of this life-threatening condition can be due to Macklin phenomenon post-cytokine-mediated diffuse alveolar injury, patient self-inflicted lung injury (P-SILI), and barotrauma in mechanically ventilated patients. The presence of pneumomediastinum is associated with higher mortality rates, prolonged intensive care unit (ICU) stays making it a poor prognostic marker. There is no consensus regarding its management in COVID-19 patients although both aggressive and conservative strategies have been tried.

Keywords: covid-19; macklin phenomenon; patient self-induced lung injury; pneumomediastinum; pneumothorax.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. High-resolution computed tomography of the thorax-axial section showing pneumomediastinum (red arrow) and pneumothorax (blue arrow).
Figure 2
Figure 2. Patient put on high flow nasal cannula.
Figure 3
Figure 3. High-resolution computed tomography of the thorax-axial section showing pneumomediastinum (red arrow) and pneumothorax (blue arrow).
Figure 4
Figure 4. Volume rendered technique (VRT) image of the chest wall showing pigtail (red arrow), Ryle’s tube (green arrow) and intercostal drainage tube (yellow arrow).
Figure 5
Figure 5. Volume rendered technique (VRT) image of the thorax-axial section showing tip of the pigtail catheter in the mediastinum (red arrow). Also note the residual pneumomediastinum (yellow arrow).
Figure 6
Figure 6. (A) High-resolution computed tomography of the thorax – sagittal section showing pneumomediastinum (red arrow). (B) High-resolution computed tomography of the thorax – sagittal section showing reduction in the size of the pneumomediastinum following pigtail insertion (red arrow).
Figure 7
Figure 7. High-resolution computed tomography of the thorax-axial section showing pneumomediastinum (red arrow).
Figure 8
Figure 8. High-resolution computed tomography of the thorax-axial section showing pneumomediastinum (red arrow) and pneumothorax (blue arrow).
See this image and copyright information in PMC

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