Pneumomediastinum in patients with COVID-19 undergoing CT pulmonary angiography: a retrospective cohort study

Abstract

BackgroundVarious complications have been reported in patients with COVID-19 including pneumomediastinum.MethodsThe primary objective of the study was to determine the incidence of pneumomediastinum in COVID-19 positive patients who underwent CT pulmonary angiography (CTPA). The secondary objectives were to analyse if the incidence of pneumomediastinum changed between March and May 2020 (peak of the first wave in the UK) and January 2021 (peak of the second wave in the UK) and to determine the mortality rate in patients with pneumomediastinum. We undertook an observational, retrospective, single-centre, cohort study of patients with COVID-19 admitted to Northwick Park Hospital.Results74 patients in the first wave and 220 patients in the second wave met the study criteria. Two patients during the first wave and eleven patients during the second wave developed pneumomediastinum.ConclusionsThe incidence of pneumomediastinum changed from 2.7% during the first wave to 5% during the second wave and this change was not statistically significant (p value 0.4057). The difference in mortality rates of patients with pneumomediastinum in both waves of COVID-19 (69.23%) versus patients without pneumomediastinum in both waves of COVID-19 (25.62%) was statistically significant (p value 0.0005). Many patients with pneumomediastinum were ventilated, which could be a confounding factor. When controlling for ventilation, there was no statistically significant difference in the mortality rates of ventilated patients with pneumomediastinum (81.81%) versus ventilated patients without pneumomediastinum (59.30%) (p value 0.14).

Clinical Features of COVID-19 and Differentiation from Other Causes of CAP

“…166 Other studies have described rates of closer to 5%. 167 Pneumothorax is an unusual feature of other types of CAP. 168 Pneumothorax is associated with certain types of pneumonia such as Pneumocystis carinii pneumonia, 169 and other causes of ARDS, especially in those requiring mechanical ventilation.…”