Spontaneous pneumomediastinum and COVID-19 pneumonia: Report of three cases with emphasis on CT imaging

Abstract

Spontaneous pneumomediastinum (SPM) is a rare complication of coronavirus disease 2019 (COVID-19). The published literature consists mainly of case reports and small case series. There are still many questions regarding the pathogenesis, the prognostic significance and the implications on patient management. In our hospital three COVID-19 patients developed SPM: one on admission at the emergency department and the other two during hospitalization. In this study we describe their clinical course and computed tomography (CT) findings. All of them had severe disease according to the total severity score on admission CT. The management of pneumomediastinum was conservative and follow-up CT showed resolution in all patients. As the correlation between extension of parenchymal lung lesions and development of pneumomediastinum is still under investigation, we highlight the importance of reporting the severity score on chest CT in order to obtain more comparable results between different studies. Furthermore, in this tragic circumstance we also had the opportunity to familiarize ourselves with the otherwise uncommon occurrence of air along the bronchovascular sheaths (Macklin effect) and evaluate the ability of CT to detect it.

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

“…In the event of unexplained clinical deterioration in COVID-19 patients, imaging is essential to diagnose possible complications such as PM and PP [37]. Chest computed tomography (CT) is a valuable tool in screening for complications and ruling out coexisting conditions [28]. The most common CT finding is peripheral, multifocal, bilateral, and GGO with or without consolidation.…”

La génesis fisiopatológica del neumomediastino espontáneo por infección por SARS-CoV-2

“…Esta aberración produce lesión al tejido de revestimiento epitelial alveolar, favoreciendo respuesta proinflamatoria desregulada, tormenta de citocinas y quimiocinas (interleucina [IL] 1, IL-6, IL-10) producto de la diferenciación de los macrófagos M1 activados por la infección por SARS-CoV-2, este resultado atrae al sitio de lesión a células blancas como monocitos, células T y otros macrófagos, causando mayor inflamación y liberación del interferón gamma, factor de crecimiento transformante beta y factor de necrosis tumoral alfa, lo que promueve aún más la respuesta inmunitaria descontrolada, convirtiéndose en un ciclo dañino para las células alveolares potenciando la lesión pulmonar 4,5 .…”