Spontaneous Pneumomediastinum in Patients Diagnosed with COVID-19: A Case Series with Review of Literature

Abstract

Spontaneous pneumomediastinum is a rare condition defined by the presence of air in the mediastinum in the absence of traumatic or iatrogenic. Although the imaging findings and complications of SARS-CoV-2 infection have been reported many times, there are few reports of the prevalence and outcomes of patients with spontaneous pneumomediastinum. In this paper, we aimed to illustrate the different manifestations, management, and outcome of three cases of SPM in COVID-19 patients and provide an extensive review of 22 related published case reports and series of 35 patients. Statistical analysis of the reviewed articles showed that SPM in COVID-19 occurs in patients with a mean age of 55.6 ± 16.7 years. Furthermore, 80% of the 35 patients are males and almost 60% have comorbidities. Intriguingly, SPM in COVID-19 is associated with a 28.5% mortality rate. These findings are consistent with our case series and are different from previous reports of SPM in non-COVID-19 cases where it most commonly occurs in younger individuals and has a self-limiting course with a good outcome. Therefore, SPM in COVID-19 patients occurs in older patients and is potentially associated with a higher mortality rate. Further studies are necessary to assess its role as a prognostic marker of poor outcome.

A Rare Complication of Pneumopericardium, Spontaneous Pneumothorax, and Subcutaneous Emphysema in a COVID-19 Pneumonia Patient Treated With High Flow Nasal Cannula

“…COVID-19 related SPM affects an older population aged 38-72 years of age versus 5-34 years for non-COVID SPM [ 8 ]. COVID-19 related SPM has been associated with a more severe course of the disease and a mortality rate of 28.5% versus non-COVID SPM, which has an estimated mortality rate of 5.6% [ 1 ].…”

Air leaks in COVID-19

“…As such, there is no single laboratory parameter that may assist in making the diagnosis or confirming AL. In patients with SARS-CoV AL, high lactate dehydrogenase (LDH) levels were associated; however, in COVID-19 patients, LDH levels are not significantly high, and mixed results are observed[ 21 , 23 , 24 ]. Other laboratory parameters associated with increased incidence of AL are increased serum bilirubin and C-reactive protein levels[ 11 ].…”

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

“…Esto produce aumento repentino de la presión en la vía aérea distal desencadenando ruptura de la pleural visceral, conductos y sacos alveolares. El presente aire alveolar se dirige hacia el espacio pleural y la presión intrapleural va perdiendo su negatividad hasta volverse positiva; asimismo, hay rotura alveolar, favoreciendo la presencia de aire en el intersticio pulmonar con traslocación a mediastino 8 .…”