Occult pneumomediastinum in a SARS patient presenting as recurrent chest pain and acute ECG changes mimicking acute coronary syndrome

Tse, Tak Sun; Tsui, Kin-Lam; Yam, Loretta Yin‐Chun; So, Loletta K-Y; Lau, Arthur Chun‐Wing; Chan, Kwok-Keung; Li, Shu-Kin

doi:10.1111/j.1440-1843.2004.00569.x

Cited by 13 publications

(12 citation statements)

References 7 publications

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“…Separately, Hasegawa et al[ 8 ] showed two children infected with the flu virus of H1N1 who developed SPM. Another elderly patient diagnosed with severe acute respiratory syndrome (SARS) presenting as recurrent chest pain and reversible electrocardiography changes was also found to develop pneumomediastinum though she had weaned from ventilatory support[ 9 ]. Autopsy results from COVID-19 patients commonly show bilateral, diffuse alveolar damage and interstitial mononuclear inflammatory infiltrates[ 10 ], suggesting the effect of infection.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous pneumomediastinum in an elderly COVID-19 patient: A case report

Kong

Gao

et al. 2020

WJCC

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BACKGROUND Spontaneous pneumomediastinum (SPM) is more common in young adults, usually caused by external factors like trauma. It causes symptoms such as chest pain or dyspnea, but it is rare to see elderly patients who develop SPM. Here we report the case of an elderly patient diagnosed with coronavirus disease 2019 (COVID-19) who neither got mechanical ventilation nor had chest trauma but were found to develop SPM for unknown reason. CASE SUMMARY A 62-year-old man complained of a 14-d history of fever accompanied by dry cough, shortness of breath, wheezing, myalgia, nausea, and vomiting. Real-time fluorescence polymerase chain reaction confirmed the diagnosis of COVID-19. The patient was treated with supplementary oxygen by nasal cannula and gamma globulin. Other symptomatic treatments included antibacterial and antiviral treatments. On day 4 of hospitalization, he reported sudden onset of dyspnea. On day 6, he was somnolent. On day 12, the patient reported worsening right-sided chest pain which eventually progressed to bilateral chest pain. He was diagnosed with SPM, with no clear trigger found. Conservative treatment was administrated. During follow-up, the pneumomediastinum had resolved and the patient recovered without other complications. CONCLUSION We presume that aging lung changes and bronchopulmonary infection play an important part in the onset of SPM in COVID-19, but severe acute respiratory syndrome may represent a separate pathophysiologic mechanism for pneumomediastinum. Although the incidence of SPM in elderly patients is low, clinicians should be alert to the possibility of SPM in those infected with severe acute respiratory syndrome coronavirus 2 for life-threatening complications such as cardiorespiratory arrest may occur.

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Section: Discussionmentioning

confidence: 99%

Spontaneous pneumomediastinum in an elderly COVID-19 patient: A case report

Kong

Gao

et al. 2020

WJCC

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“…Pneumomediastinum can present with T-wave inversion [3][4][5], electrical alternans [2], and low voltage [6]. These findings have been attributed to several mechanisms including cardiac rotation or displacement, right ventricular enlargement, and the insulation of the heart by mediastinal air [1][2][3][4][5][6].…”

Section: Discussionmentioning

confidence: 99%

“…This condition has been associated with a variety of electrocardiographic (ECG) abnormalities including electrical alternans, T-wave inversion, loss of R wave progression, and low voltage QRS [2][3][4][5][6]. The following report describes a case of pneumomediastinum with apparent ST-segment elevation noted in the electrocardiogram that suggested acute myocardial infarction.…”

Section: Introductionmentioning

confidence: 99%

Pneumomediastinum mimicking acute ST-segment elevation myocardial infarction

Brearley

Taylor

Haley

et al. 2007

International Journal of Cardiology

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“…Dans l'étude de Chu et al [6], incluant 123 patients ayant un SRAS, 13 d'entre eux (10,5 %) avaient un PMS. Au cours de cette pandémie, Tse et al [7] ont décrit un cas de PMS simulant un syndrome coronarien aigu chez une femme de 64 ans souffrant du SRAS.…”

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