Clinical Characteristics and Outcome of Pneumomediastinum in Patients with COVID-19 Pneumonia

Abstract

Introduction: Pneumomediastinum (PM) is characterized by the presence of air within the mediastinum. The association between PM and coronavirus 2019 (COVID-19) has not been well established in the current literature. We sought to summarize the limited body of literature regarding PM in patients with COVID-19 and characterize the presentation and clinical outcomes of PM in patients with severe acute respiratory syndrome (SARS)-COV-2 pneumonia at our institution to better define the incidence, prognosis, and available treatment for this condition. Materials and Methods: All patients with a proven diagnosis of COVID-19 and PM between March 18, 2020 and May 5, 2020 were identified through hospital records. Retrospective analysis of radiology records and chart review were conducted. Clinical characteristics and outcomes were collected and descriptive statistics was analyzed. Results: Thirty-six patients met inclusion criteria. Out of the 346 intubated COVID-19 patients, 34 (10%) had PM. The incidence of PM increased for the first 4 weeks of the pandemic, and then began to decrease by week 5. At the endpoint of the study, 12 (33.33%) patients were alive and 24 patients (66.67%) had died. Conclusion: PM, although a rare phenomenon, was more prevalent in COVID-19 patients compared with historical patients with adult respiratory distress syndrome. The etiology of this condition may be attributed to higher susceptibility of patients infected with SARS-CoV-2 to a combination of barotrauma and airway injury.

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

“…Viral infection associated tracheal oedema increasing risk of tracheal injury during intubation, increased alveolar pressure due to violent coughing secondary to viral infections may all attribute to the development of PM in COVID-19 patients. 10,16,17 Males seem to be more affected than the females. In our series, two (66%) out of three were male patients and mean age was 60.3 years which is in concordance with results of the study by Kangas-Dick et al 10 Two patients had diabetes, and two patients had hypertension in our series.…”

Incidence of pneumomediastinum in COVID-19: A single-center comparison between 1st and 2nd wave

“…We restricted the analysis to the ascending phases of the 1 st and 2 nd epidemic waves in order to compare time periods with a similar incremental trend in daily hospitalizations ( Figure 1 ) and a similar workload to health-care personnel. Indeed, the latter factor has been shown to affect pneumomediastinum frequency [ 6 ], thus possibly acting as a confounder. Crude incidence rates were reported as events/1000 patient-days, and the mid-p adjusted exact test was applied for comparison.…”

Spontaneous pneumomediastin and pneumopericardium in patients with COVID-19; case report

“…manifestaciones y complicaciones clínicas , en nuestro reporte la paciente fue claramente sintomática desde el inicio. La disnea no es uno de los síntomas más comunes del COVID-19 así como se reporta en la literatura (10) mundial e incluso en Paraguay la Dirección General de Vigilancia de la Salud del Ministerio de Salud Pública y Bienestar Social al 06 de febrero del 2021 ha reportado un 56% de los pacientes con síntomas, de los (11) que la disnea se presenta en un 16% . Es interesante notar que en la paciente reportada la disnea recién se manifestó a las 48 horas de iniciado el cuadro, siendo llamativa su evolución tórpida y estar acompañada en reiteradas ocasiones por otro síntoma poco común en (10) el COVID-19 como lo es el dolor torácico , llegando incluso al desvanecimiento por ambos síntomas.…”