Pneumomediastinum in a Critically Ill Coronavirus Disease 2019 (Covid-19) Patient

Hayrabedian, Moses; Sreedhar, Rajagopal; Nayeemuddin, Faraaz

doi:10.1016/j.chest.2020.08.713

Chest

2020

DOI: 10.1016/j.chest.2020.08.713

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Pneumomediastinum in a Critically Ill Coronavirus Disease 2019 (Covid-19) Patient

Moses Hayrabedian¹,

Rajagopal Sreedhar²,

Faraaz Nayeemuddin³

Abstract: The Coronavirus Disease 2019 (COVID-19) pandemic has displayed heterogeneity in disease manifestations and complications; cardiac, renal, neurological complications and coagulopathy are reported. We present a case of COVID-19 with pneumomediastinum.

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“…Despite the plausibility of the aforementioned mechanisms which may involve a combination of bronchioloalveolar inflammation associated epithelial-interstitial rupture, transalveolar stress, differential strain (with or without purely distributed (self) imposed mechanical thoracic energy for the development of pneumomediastinum), visual demonstration of the Macklin effect has not been shown. Furthermore, the absence of pneumothorax in high-resolution CT scans in certain cases of pneumomediastinum, sustains the further question of whether and how air can reach the mediastinum without causing a visible breach in the alveolar lung parenchyma [ 30 , 31 ].…”

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confidence: 99%

Pneumomediastinum in COVID-19: Merely a Matter of Lung Frailty?

2021

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mentioning

confidence: 99%

Pneumomediastinum in COVID-19: Merely a Matter of Lung Frailty?

2021

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Prevalence and Risk Factors of Pneumomediastinum and Subcutaneous Emphysema in COVID-19 Patients: A Retrospective Cohort Study

Bozorgmehr,

Jobeiri,

Khameneh Bagheri

et al. 2024

Jundishapur J Microbiol

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Background: Pneumomediastinum (PM), the presence of air in the mediastinum, is a rare condition. Severe COVID-19 patients are at an increased risk for PM and subcutaneous emphysema (SCE) due to alveolar rupture from diffuse lung injury. Despite the increased prevalence of PM in COVID-19 patients, the optimal treatment approach remains debated. Objectives: This study investigated the prevalence, outcomes, and associated risk factors for PM and SCE in COVID-19 patients. Methods: In this retrospective cohort study, COVID-19 patients aged 18 - 80 with a positive PCR test and chest CT scan from April to December 2021 were included. Cases of PM and SCE were identified, and an equal number of age, sex, and severity-matched COVID-19 patients were selected as the control group for comparison. Results: Of the 1 557 patients, 89 (5.71%) developed PM. Among these patients, 63 (4.04%) developed SCE. Patients with these complications had significantly longer hospital stays. No significant association was found between comorbidities and the occurrence of PM or SCE. The use of Venturi and non-rebreather masks (OR = 3.075, 95% CI: 1.658 - 5.705), non-invasive ventilation (NIV) (OR = 16.941, 95% CI: 6.545 - 43.851), and invasive mechanical ventilation (IMV) (OR = 5.703, 95% CI: 2.595 - 12.533) were significantly associated with these complications (P < 0.0001). The mortality rate among severe COVID-19 patients with PM was 43.8%, and 47.6% among those with SCE. Conclusions: Pneumomediastinum and SCE are rare complications in COVID-19 patients, associated with prolonged hospitalization. The use of certain respiratory support methods, including NIV and IMV, significantly increased the risk of these complications. Both PM and SCE are linked to high mortality rates, highlighting the need for careful management in affected patients.

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

Alsulaihebi¹,

Almaghrabi²,

Alqarni³

et al. 2022

Cureus

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There is an emerging body of literature describing an increasing incidence of pneumomediastinum and, to a lesser extent, pneumopericardium as a complication of COVID-19. However, the literature lacks information regarding patients' characteristics and a general view of this unusual condition. The purpose of this paper is to summarize the current literature on this phenomenon. In this study, we summarize the risk factors/etiology, imaging modalities, management, and prognosis of known cases in the literature. In total, 48 articles were included in the study, ranging from case reports to case series. Most patients were male (83.3%). The overall mortality rate was 27.1% and the recovery rate was 62.5%.

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Pneumomediastinum in a Critically Ill Coronavirus Disease 2019 (Covid-19) Patient

Abstract: The Coronavirus Disease 2019 (COVID-19) pandemic has displayed heterogeneity in disease manifestations and complications; cardiac, renal, neurological complications and coagulopathy are reported. We present a case of COVID-19 with pneumomediastinum.

Cited by 3 publications

References 0 publications

Pneumomediastinum in COVID-19: Merely a Matter of Lung Frailty?

Pneumomediastinum in COVID-19: Merely a Matter of Lung Frailty?

Prevalence and Risk Factors of Pneumomediastinum and Subcutaneous Emphysema in COVID-19 Patients: A Retrospective Cohort Study

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

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