Pathological Presence of Free Air in the Thorax: Pneumothorax and Pneumomediastinum as a Complication of COVID-19

Abstract

Introduction: The abnormal presence of free air in the thorax, pneumothorax, and pneumomediastinum are complications for critically ill patients suffering from coronavirus disease 2019 (COVID-19). The development of these events may lead to a poor prognosis and make the management of this category of patients more difficult.

Study design: We performed an observational retrospective study, including patients with SARS-CoV-2 infection and pneumonia who were hospitalized, to analyze the cases that developed pneumothorax or pneumomediastinum as a complication.

Results: A total of 28 cases (1.51%) from 1844 patients with SARS-CoV-2 pneumonia developed pneumothorax or pneumomediastinum during hospitalization. Of them, 21 (75%) needed intensive care unit admission and ventilation, and 10 (35.71) were cured.

Conclusion: The male gender is more probable to be involved in the development of pneumothorax or pneumomediastinum in patients with SARS-CoV-2 pneumonia. The incidence of these events is low, and conservative treatment could provide a better outcome.

Keywords: covid-19; pandemic; pneumomediastinum; pneumothorax; subcutaneous emphysema.

Figure 1. Chest computed tomography scan of a 63-year-old male with severe SARS-CoV-2 pneumonia and spontaneous right hydropneumothorax, with no previous chronic pulmonary disease.

Figure 2. Series of images of computed tomography scan of a 51-year-old male with severe pneumonia done on days three, 10, and 15 after admission. The presence of spontaneous pneumomediastinum and subcutaneous emphysema on day 10 is notable, with the evident regression of the lesions on day 15, even when intubation and mechanical ventilation were needed.