A Complication of Pneumothorax and Pneumomediastinum in a Non-Intubated Patient With COVID-19: A Case Report

Abstract

COVID-19 disease can lead to multiple complications such as severe acute respiratory distress syndrome (ARDS), coagulopathy, renal failure, cardiac and neurological complications. We describe a case of a patient who developed pneumothorax and pneumomediastinum in the setting of COVID-19 without having ARDS or requiring mechanical ventilation. Our patient developed sudden onset of shortness of breath and desaturation. Chest X-ray and CT chest revealed pneumothorax and pneumomediastinum. Though pneumothorax in pulmonary infection is most likely associated with increased airway pressure in acute respiratory distress syndrome and positive pressure mechanical ventilation. Pneumothorax is a life-threatening complication and if diagnosed early it can reduce mortality. In patients with COVID-19 infection, sudden clinical worsening with shortness of breath and desaturation should prompt the clinician to look for potentially treatable causes such as pneumothorax.

Clinical outcomes of pleural drainage on pneumothorax and hydrothorax in critically ill patients with COVID-19: A case series with literature review

“…While pneumothorax is a well-known complication of mechanical ventilation, patients with high-flow nasal cannula (HFNC) oxygen therapy have also been reported to have pneumothorax. 8 , 16 , 17 Ashraf et al. also found a case with spontaneous pneumothorax which occurred 21 days after discharge.…”

“…The mortalities of these patients were 100%, 50% and 100%, respectively. Eight patients (72.7%) died, with a median course of 35.5 16 days. Three patients (27.3%) were transferred out of the ICU, with a median course of 78 2 days.…”

“… 18 These finding suggested that the primary disease (COVID-19) itself might also be a risk factor. Some authors suggested that pulmonary embolisms, 16 diffuse alveolar damage, 16 infections 19 might be the reasons. Underlying diseases of the lung might also be a risk factor, as patients in our study were older than critical patients reported elsewhere.…”

Subcutaneous emphysema and spontaneous pneumomediastinum in non-intubated COVID-19 patient: Presenting unusual case report

“…The mechanism of pneumomediastinum in non-intubated COVID-19 patients remains unclear. Up to date, only a few cases have been published [ [3] , [4] , [5] , [6] , [7] ]. In the present paper, subcutaneous emphysema and spontaneous pneumomediastinum occurred at the same time, with no past history of pulmonary diseases, and smoking of the patient.…”

“…In non- intubated COVID-19 patients, subcutaneous emphysema and spontaneous pneumomediastinum (SP) are very rare, with incidence rates of 3.0 and 1.2 per 100,000, respectively [ 3 ]. To date only a few cases have been reported [ [3] , [4] , [5] , [6] , [7] ]. Here, we present an unusual case of 63-year-old male with linked with subcutaneous emphysema and spontaneous pneumomediastinum.…”