Pneumomediastinum in COVID-19 Patients with Acute Respiratory Distress Syndrome.

BACKGROUND: Pneumomediastinum, an uncommon entity, has been on the rise with increasing cases of COVID-Acute respiratory distress syndrome. It has been unclear whether this entity represents an indicator of poor clinical outcome or not. The aims of this study were to find out the incidence of pneumomediastinum in COVID-Acute respiratory distress syndrome patients, describe their clinical characteristics and try to explain its plausible mechanisms.. METHODS: A descriptive, cross-sectional study was carried out in the ICU of our hospital among 280 patients admitted with COVID-Acute respiratory distress syndrome over a period of 6 months. Demographics along with various clinical, laboratory, and radiological parameters were analyzed. Relevant statistical analyses were done to summarize our findings. RESULTS: The incidence of pneumomediastinum in COVID-ARDS patients was 2.8%. All patients were male, none had pulmonary co-morbidities and six of them (60%) were on invasive mechanical ventilation. All intubated patients were on lung protective mechanical ventilation. The median PEEP, peak airway pressure and plateau pressure were 10 (IQR: 4), 29 (IQR: 8) and 28 (IQR: 4) respectively. The mean CT severity score was 22.7 (SD: 1.64). Five patients died after 6.8 days (SD: 4.8) of diagnosis. The average hospital stay was of 34 days. CONCLUSIONS: Pneumomediastinum is a possible complication of COVID-Acute respiratory distress syndrome which could signify the disease severity and vice versa. Furthermore, it could be an indicator of relatively poor prognosis and therefore requires larger studies to establish the association.

Pediatric Radiology in Era of COVID-19, International Consensus and What Lies Beyond Pneumonia: A Review.

Diagnostic radiology plays a crucial role in children. The pediatric population has been less studied than the adult population since the initial period of the COVID-19 pandemic to date. Realizing the potential utility of structured reporting, different guidelines and international consensus statements regarding COVID-19 in the pediatric population have been released in recent times. Different clinical and radiological manifestations in children have been evolving in this period of uncertainty and are different from the adult population in certain aspects. Apart from the involvement of lungs, a multisystemic inflammatory syndrome in children or pediatric multi systemic inflammatory syndrome is unique in children. Therefore, awareness of the recent consensus, structural uniform reporting and multi-organ involving patterns in COVID-19 can guide radiologists for a better understanding of this complex novel disease leading to early diagnosis and timely treatment of affected children.