Spontaneous Pneumomediastinum Associated With SARS-CoV-2: Infrequent Complication of the Novel Disease

Wegner, Urszula; Jeffery, Gerardo; Abrajan, Octavio; Sampablo, Italo; Singh, Chitrangada

doi:10.7759/cureus.9189

Cited by 9 publications

(5 citation statements)

References 10 publications

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“…7 By comparison, several single case reports and small case series of PM associated with COVID-19 have been published, all of whom were treated conservatively. [8][9][10][20][21][22][23] In our cohort more than half (n = 20) were managed without the placement of any drain.…”

Section: Discussionmentioning

confidence: 95%

Clinical Characteristics and Outcome of Pneumomediastinum in Patients with COVID-19 Pneumonia

Kangas-Dick

Gazivoda

Ibrahim

et al. 2021

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Introduction: Pneumomediastinum (PM) is characterized by the presence of air within the mediastinum. The association between PM and coronavirus 2019 (COVID-19) has not been well established in the current literature. We sought to summarize the limited body of literature regarding PM in patients with COVID-19 and characterize the presentation and clinical outcomes of PM in patients with severe acute respiratory syndrome (SARS)-COV-2 pneumonia at our institution to better define the incidence, prognosis, and available treatment for this condition. Materials and Methods: All patients with a proven diagnosis of COVID-19 and PM between March 18, 2020 and May 5, 2020 were identified through hospital records. Retrospective analysis of radiology records and chart review were conducted. Clinical characteristics and outcomes were collected and descriptive statistics was analyzed. Results: Thirty-six patients met inclusion criteria. Out of the 346 intubated COVID-19 patients, 34 (10%) had PM. The incidence of PM increased for the first 4 weeks of the pandemic, and then began to decrease by week 5. At the endpoint of the study, 12 (33.33%) patients were alive and 24 patients (66.67%) had died. Conclusion: PM, although a rare phenomenon, was more prevalent in COVID-19 patients compared with historical patients with adult respiratory distress syndrome. The etiology of this condition may be attributed to higher susceptibility of patients infected with SARS-CoV-2 to a combination of barotrauma and airway injury.

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Section: Discussionmentioning

confidence: 95%

Clinical Characteristics and Outcome of Pneumomediastinum in Patients with COVID-19 Pneumonia

Kangas-Dick

Gazivoda

Ibrahim

et al. 2021

Journal of Laparoendoscopic & Advanced Surgical Techniques

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“…SPM itself is often benign and self-limiting without need for invasive interventions. 5 Our patient highlights a rare SARS-CoV-2 complication of SPM. Aside from SARS-CoV-2, the patient did not have any predisposing factors for the development of pneumomediastinum, and he did not have exposure to positive pressure ventilation.…”

Section: Discussionmentioning

confidence: 69%

“…However, it reportedly has presented in infected patients regardless of age or comorbidities. [4][5][6][7] We present a rare case of SPM diagnosed at presentation in a patient with SARS-CoV-2 pneumonia who did not have exposure to positive pressure ventilation throughout his entire course.…”

Section: Introductionmentioning

confidence: 99%

A case of spontaneous pneumomediastinum in a patient with severe SARS-CoV-2 and a review of the literature

Hua

Shah

Perez-Corral

2021

SAGE Open Medical Case Reports

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Spontaneous pneumomediastinum is defined as having an etiology that is not related to surgery, trauma, or mechanical ventilation. Precipitating causes of spontaneous pneumomediastinum include coughing, exercise, vomiting, infection, underlying lung diseases such as asthma, and illicit drugs. Symptoms include chest pain, shortness of breath, and dysphagia. A 54-year-old man presented with 2 weeks of shortness of breath, cough, and fever. He was admitted for severe SARS-CoV-2 pneumonia and acute hypoxic respiratory failure requiring non-rebreather mask. Chest imaging on admission showed bilateral peripheral consolidations and pneumomediastinum with subcutaneous emphysema. No precipitating event was identified. He did not require initiation of positive pressure ventilation throughout his admission. On hospital day 7, chest imaging showed resolution of pneumomediastinum and subcutaneous emphysema, and he was successfully discharged on oxygen therapy. Spontaneous pneumomediastinum is a rare complication of severe acute respiratory syndrome coronavirus 2 infection. Spontaneous pneumomediastinum is typically benign and self-limiting, requiring only supportive treatment.

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“…Supplementary Table S3. The Lists of included studies [ 6 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , …”

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Prognosis of Spontaneous Pneumothorax/Pneumomediastinum in Coronavirus Disease 2019: The CoBiF Score

Woo¹,

Kipkorir²,

Marza³

et al. 2022

JCM

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Objectives: Pneumothorax and pneumomediastinum are associated with high mortality in invasively ventilated coronavirus disease 2019 (COVID-19) patients; however, the mortality rates among non-intubated patients remain unknown. We aimed to analyze the clinical features of COVID-19-associated pneumothorax/pneumomediastinum in non-intubated patients and identify risk factors for mortality. Methods: We searched PubMed Scopus and Embase from January 2020 to December 2021. We performed a pooled analysis of 151 patients with no invasive mechanical ventilation history from 17 case series and 87 case reports. Subsequently, we developed a novel scoring system to predict in-hospital mortality; the system was further validated in multinational cohorts from ten countries (n = 133). Results: Clinical scenarios included pneumothorax/pneumomediastinum at presentation (n = 68), pneumothorax/pneumomediastinum onset during hospitalization (n = 65), and pneumothorax/pneumomediastinum development after recent COVID-19 treatment (n = 18). Significant differences were not observed in clinical outcomes between patients with pneumomediastinum and pneumothorax (± pneumomediastinum). The overall mortality rate of pneumothorax/pneumomediastinum was 23.2%. Risk factor analysis revealed that comorbidities bilateral pneumothorax and fever at pneumothorax/pneumomediastinum presentation were predictors for mortality. In the new scoring system, i.e., the CoBiF system, the area under the curve which was used to assess the predictability of mortality was 0.887. External validation results were also promising (area under the curve: 0.709). Conclusion: The presence of comorbidity bilateral pneumothorax and fever on presentation are significantly associated with poor prognosis in COVID-19 patients with spontaneous pneumothorax/pneumomediastinum. The CoBiF score can predict mortality in clinical settings as well as simplify the identification and appropriate management of patients at high risk.

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Spontaneous Pneumomediastinum Associated With SARS-CoV-2: Infrequent Complication of the Novel Disease

Cited by 9 publications

References 10 publications

Clinical Characteristics and Outcome of Pneumomediastinum in Patients with COVID-19 Pneumonia

Clinical Characteristics and Outcome of Pneumomediastinum in Patients with COVID-19 Pneumonia

A case of spontaneous pneumomediastinum in a patient with severe SARS-CoV-2 and a review of the literature

Prognosis of Spontaneous Pneumothorax/Pneumomediastinum in Coronavirus Disease 2019: The CoBiF Score

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