COVID-19-Associated Spontaneous Pneumomediastinum and Pneumopericardium: Review of Case Series

Abstract

Coronavirus disease 2019 (COVID-19) and its spectrum of respiratory illnesses ranging from mild to severe and critically ill have been well established. Spontaneous pneumomediastinum and pneumopericardium (PP) appear to be less reported entities and have been found to be reported complications in COVID-19 infection. Pneumomediastinum (PM) and PP are characterized by the presence of air in the mediastinal and pericardial cavity, respectively. Although, generally, secondary to trauma or underlying lung conditions like asthma, bronchiolitis obliterans, and blunt trauma, it can also occur spontaneously without an evident primary cause. PM and PP are increasingly reported complications in COVID-19 patients adversely affecting clinical outcomes. We present a case series of patients with spontaneous pneumomediastinum and pneumopericardium in the presence of underlying COVID-19 infection and their management at our academic medical center.

Pneumomediastinum and Pneumopericardium as Uncommon Complications of COVID-19 Infection: A Review Article

“…Strategies to lower the required PEEP settings, such as treating reversible causes and applying for a proning position, should be considered [25]. In their case series, Suresh et al [26] applied a protocol that involves prone positioning for 18 hours a day to enhance oxygenation in their patients. Interestingly, frequent proning in mechanically ventilated patients was suggested to cause barotrauma, leading to the development of PM [44].…”