Spontaneous tension pneumothorax as a complication of Coronavirus disease 2019: Case report and literature review

Abstract

Primary spontaneous tension pneumothorax (STP) is a rare and life‐threatening condition. We report a case of COVID‐19‐pneumonia patient who developed STP as a complication. He had a prolonged hospital stay and was ultimately discharged asymptomatic. A systematic literature search was performed to review studies ( N =12) reporting STP in the setting of COVID‐19.

Spontaneous tension pneumomediastinum with pneumothorax and subcutaneous emphysema as a complication of COVID‐19 disease

“…14,16,17 Of note, there was some previous report of tension pneumomediastinum secondary to COVID-19 that resolved with bedside mediastinotomy via the Chamberlain procedure. 10,[16][17][18] In our patient with COVID-19, a tension pneumomediastinum formed in the chest and SE in the neck, with subsequent spread to the arms bilaterally and with the enlarging PM caused difficulty breathing and progressive dysphonia with an increased pitch in the tone of his voice and engorge the jugular vein with cyanosis of face. Due to impending airway obstruction, the patient was sent for emergent mediastinal drainage with bilaterally chest tube insertion in anterior mediastinum and bilaterally subclavicular incision for evacuation of SE.…”

“…After review of the current literature, Some describe cases report of operative management for a massive tension pneumomediastinum secondary to COVID-19. 14,16,17 Of note, there was some previous report of tension pneumomediastinum secondary to COVID-19 that resolved with bedside mediastinotomy via the Chamberlain procedure. 10,[16][17][18] In our patient with COVID-19, a tension pneumomediastinum formed in the chest and SE in the neck, with subsequent spread to the arms bilaterally and with the enlarging PM caused difficulty breathing and progressive dysphonia with an increased pitch in the tone of his voice and engorge the jugular vein with cyanosis of face.…”

“…In particular, compression of the great vessels can lead to decreased venous return, hypotension with tachycardia, and potential cardiovascular collapse. 10,12,16 Currently, management for tension pneumomediastinum in the COVID-19 population has largely been conservative. 14,17 Different approaches include reducing airway pressures and adjusting ventilator settings to allow for permissive hypercapnia in an effort to reduce pressure gradients across the mediastinal surface.…”

Spontaneous tension pneumomediastinum with pneumothorax and subcutaneous emphysema as a complication of COVID-19 Disease

“…Increased pressure in the mediastinum can compress mediastinal contents. In particular, compression of the great vessels can lead to decreased venous return, hypotension with tachycardia, and potential cardiovascular collapse (9,11,14) Currently, management for tension pneumomediastinum in the COVID-19 population has largely been conservative (12,15). Different approaches include reducing airway pressures and adjusting ventilator settings to allow for permissive hypercapnia in an effort to reduce pressure gradients across the mediastinal surface (3,15).…”

“…After review of the current literature, Some describe cases report of operative management for a massive tension pneumomediastinum secondary to COVID-19 (12,14,15).Of note, there was some previous report of tension pneumomediastinum secondary to COVID-19 that resolved with bedside mediastinotomy via the Chamberlain procedure (11,(14)(15)(16) In our patient with COVID-19, a tension pneumomediastinum formed in the chest and SE in the neck, with subsequent spread to the arms bilaterally and with the enlarging pneumomediastinum caused difficulty breathing and progressive dysphonia with an increased pitch in the tone of his voice and engorge the jugular vein with cyanosis of face. Due to impending airway obstruction, the patient was sent for emergent mediastinal drainage with bilaterally chest tube insertion in anterior mediastinum and bilaterally sub-clavicular incision for evacuation of SE.…”