Spontaneous Pneumomediastinum: A Possible Severe Condition in SARS-CoV-2 Pneumonia

Abstract

Background Spontaneous pneumomediastinum (SP) is the presence of free air into extra-alveolar tissues within the mediastinum, without notion of trauma. This rare condition may occur as a complication of an underlying severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia. Higher rates of mechanical ventilation are reported in coronavirus disease 2019 (COVID-19) patients with pneumomediastinum. Case Description We report two cases of COVID-19 infected patients suffering from mild and severe SP and their outcome. Discussion The objective of this report is to review the literature about this condition. We discuss about the pathological pathways underlying this complication and how it reflects the severity of COVID-19 pneumonia. Conclusion Currently, it remains unclear if SP in SARS-CoV-2 pneumonia is a potential predictor of disease worsening, for it does not seem to be related with a higher rate of mortality.

ST-Segment Elevation Secondary to Spontaneous Pneumomediastinum in the Setting of COVID-19 Infection: A Case Report and Literature Review

“…PM is classified into two categories; one, with an instigating event, is referred to as secondary PM, and the other occurs when free air is discovered in the mediastinal cavity without a clear etiology, and it is referred to as spontaneous PM [ 1 ]. Pulmonary barotrauma during invasive mechanical ventilation, endoscopic procedures, central line placements, and blunt face trauma are the main risk factors for secondary PM [ 2 ]. Tobacco use, chronic obstructive pulmonary disease, and asthma are the main risk factors for idiopathic spontaneous PM.…”

“…Tobacco use, chronic obstructive pulmonary disease, and asthma are the main risk factors for idiopathic spontaneous PM. However, spontaneous PM can also occur as a rare complication of infectious pneumonia, most commonly after staphylococcal, tuberculosis, or fungal pneumonia; however, it is relatively rare after viral pneumonia [ 2 ].…”

“…Recent publications have suggested an association between COVID-19 and PM. The association has been linked to the barotrauma from mechanical ventilation in these patients; however, there have also been increasing reports of spontaneous PM in the absence of mechanical ventilation [ 2 - 8 ]. The exact pathophysiology mechanisms of spontaneous PM in COVID-19 patients still remain unclear.…”