Management of Pneumomediastinum Associated with H1N1 Pneumonia: A Case Report

Abstract

H1N1 is seen in tropical countries like India, occurring irrespective of the season. Complications of the disease are frequently encountered and there is little in the way or guidelines as to the how these should be managed. The treatment of one such complication, a recurrent pneumiomediastinum is the subject of the current paper. The management followed guidance for the treatment of a similar condition known as primary spontaneous pneumomediastinum, an uncommon condition resulting from alveolar rupture-otherwise known as the Macklin phenomenon.

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

“…It is possible that tracheal manipulation, procedural airway injury, or barotrauma does not completely explain the presence of PM in COVID-19 patients as several patients in our cohort and those detailed by others developed PM in the absence of intubation. 7,11 Ye et al postulated that the ''cytokine storm'' of severe SARS-CoV-2 infection might result in the release of air contained within ruptured alveoli tracking into the mediastinum consistent with the previously described ''Macklin Phenomenon.'' [17][18][19] It is feasible that epithelial damage may occur at the level of the alveoli in a similar manner to that of traditional ARDS.…”

“…Although relatively rare, PM has been observed in higher incidence in the setting of other viral pneumonias, including H1N1 influenza. 11 Patients with COVID-19 who lack significant physiological reserve may be particularly susceptible to the compression effects of mediastinal emphysema on the great vessels, and may mimic the clinical presentation of cardiac tamponade in severe cases. 7 Although the underlying pathological mechanism of PM in COVID-19 patients is not fully understood, it is possible that this phenomenon may be caused by increased barotrauma associated with a higher pressure or volume lung ventilation strategies as a result of increased end expiratory pressure and loss of lung compliance due to the significant alveolarassociated damage that has been demonstrated in autopsy series of patients with SARS-CoV-2 pneumonia.…”

A case report of pneumomediastinum and subcutaneous emphysema associated with pandemic COVID-19 in a 43-year-old man

“…The potential causes of this problem are severe pulmonary infection, blunt or penetrating chest trauma, diagnostic interventions, illicit drug inhalation, as well as idiopathic causes. [22][23][24][25] It can be easily recognized by computed tomography of the thorax. 11 In conclusion We have reported a case of COVID-19 pneumonia complicated by pneumomediastinum.…”

Non-invasive ventilation (NIV) induced bilateral subcutaneous emphysema in SARS COV-2 patient: A rare occurrence

“… 14 Singh and colleagues reported a case of spontaneous SE and pneumomediastinum in a patient with H1N1 pneumonia. 15 COVID-19 pneumonia has been shown to cause severe diffuse alveolar damage (DAD) secondary to direct infection of pneumocytes type I and II. Studies have demonstrated COVID-19 viral entry via angiotensin converting enzyme-2 (ACE-2) receptor into target cells including surfactant-producing type II pneumocytes causing cellular injury and dysregulation of surfactant production contributing to the development of SE and pneumomediastinum from impaired lung compliance.…”