Pneumothorax and pneumomediastinum in patients with COVID-19: A retrospective study from tertiary care institute in India

Abstract

Pneumothorax, pneumomediastinum, COVID-19 COVID-19 is associated with rarer extra-parenchymal manifestations, namely pneumothorax (PTX) and pneumomediastinum (PM) leading to complications and increased mortality. The study aims to describe the prevalence, risk factors for mortality, radiological characteristics and outcome of PTX/ PM in patients admitted with COVID-19. This was a retrospective, single-centre, observational study in patients with confirmed COVID-19 presenting with non-iatrogenic PTX/PM from April 2020 to May 2021. Details pertaining to demographics, presentation, radiological characteristics, management and outcome were collected. Cases were classified into spontaneous and barotraumatic PTX/PM and a between-group comparison was performed using Chi-square and t-test. A total of 45 cases (mean age: 53.2 years, 82% males) out of 8,294 confirmed COVID-19 patients developed PTX/PM, the calculated incidence being 0.54%. 29 cases had spontaneous PTX/PM and the remaining 17 cases were attributed to barotrauma. The most common comorbidities were diabetes-mellitus (65.3%) and hypertension (42.3%). The majority of the cases had large PTX (62.1%) with tension in 8 cases (27.5%). There were predominant right-sided pneumothoraces and five were diagnosed with bronchopleural fistula. 37.7% of cases had associated subcutaneous emphysema. The median duration of PTX/PM from symptom onset was delayed at 22.5 and 17.6 days respectively. The mean CT severity score (CTSS) was 20.5 (± 4.9) with fibrosis (53.8%), bronchiectatic changes (50%) and cystic-cavitary changes (23%). There was no statistically significant difference between the spontaneous and barotrauma cohort. 71% of cases died and the majority belonged to the barotrauma cohort. It is imperative to consider the possibility of PTX/PM in patients having COVID-19, especially in those with deterioration in the disease course, both in spontaneously breathing and mechanically ventilated patients. These patients may also have a high incidence of death, reflecting the gravity of COVID-19.

A study on the morbid histopathological changes in COVID‐19 patients with or without comorbidities using minimally invasive tissue sampling

“… 3 , 4 It can range from a mild, self‐limiting pulmonary insult to frank acute respiratory distress syndrome (ARDS) requiring invasive mechanical ventilation with poor clinical outcomes 5 and various complications. 6 , 7 , 8 , 9 , 10 Other organ systems are also affected apart from the respiratory system with protean manifestations. Involvement of the cardiovascular system, gastrointestinal tract, kidneys, and liver have been reported ranging from asymptomatic laboratory aberrations to multiorgan failure related to cytokine storm.…”

“…COVID‐19 is postulated to enter the respiratory tract and is primarily a respiratory illness with COVID‐19 pneumonia being the most commonly encountered serious clinical manifestation 3,4 . It can range from a mild, self‐limiting pulmonary insult to frank acute respiratory distress syndrome (ARDS) requiring invasive mechanical ventilation with poor clinical outcomes 5 and various complications 6–10 . Other organ systems are also affected apart from the respiratory system with protean manifestations.…”