SARS-CoV-2 pneumonia with subcutaneous emphysema, mediastinal emphysema, and pneumothorax

Abstract

Introduction: Since the end of 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has affected more than 1,000,000 population in the world. Subcutaneous emphysema and pneumothorax are uncommon complications of SARS-CoV-2 pneumonia. Herein, we describe a fatal case of SARS-CoV-2 pneumonia with subcutaneous emphysema and pneumothorax. Patient concerns: Subcutaneous emphysema was found in neck, bilateral chest walls, abdomen wall, groin area, and scrotum of a 67-year-old man. Extensive air-space opacities, subcutaneous emphysema and a small amount of pneumothorax were found in his chest X-ray scan. Echocardiography showed left ventricular enlargement with ejection fraction 20%. Diagnosis: This resident of Wuhan with laboratory-confirmed SARS-CoV-2 infection had chronic pulmonary and cardiac diseases. Liver dysfunction, myocardial injury, and coagulation disorder were suggested by laboratory findings. Pneumonia, subcutaneous emphysema, and pneumothorax were confirmed with chest X-ray. Heart failure was revealed by echocardiography. Interventions: He was transferred to intensive care unit, where invasive ventilation was used for him during the whole hospitalization. Prone position ventilation, vasoconstrictor, antibacteria, and antiviral therapy were given. Outcomes: He died on the twelfth day after admission. Conclusions: Subcutaneous emphysema and pneumothorax may occur in patients with SARS-CoV-2 pneumonia and chronic pulmonary disease. Chronic cardiac disease might be aggravated by SARS-CoV-2 infection, and develop heart failure.

Case Report: COVID-19–Associated Bilateral Spontaneous Pneumothorax—A Literature Review

“…Twelve patients had a favorable clinical course, whereas six patients passed away, resulting in a mortality rate of 33% based on the available literature ( Table 1 ). 2 – 16 Our case is the second reported bilateral spontaneous pneumothorax in the literature to the best of our knowledge.…”

“…Most of the reported cases of pneumothorax associated with COVID-19 lack traditional risk factors or underlying predisposing lung disease. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] To date, one case of COVID-19-associated spontaneous bilateral pneumothorax in COVID-19 has been described to the best of our knowledge. 12…”

Case Report: Pneumothorax and Pneumomediastinum as Uncommon Complications of COVID-19 Pneumonia—Literature Review

“…Follow-up was not reported in four patients. It is important to note that subcutaneous emphysema was a radiological finding present in 35% (7/20) of the patients, two in pneumothorax, 15,16 three in pneumomediastinum, 4,7,17 and two in both. 18,19 The treatment for COVID-19 was variable.…”

Late-onset pneumothorax in a COVID-19 patient treated with ventilation and ECMO: A case report and literature review

“…To our knowledge, five previous case reports of pneumothorax in COVID-19 patients have been published to date 9 , 10 , 11 , 12 , 13 . In addition, two cases, including this case, of COVID-19 patients with pneumothorax have developed in our hospital.…”