Mediastinal Pigtail Catheterization for Treatment of Pneumomediastinum in a COVID-19 Patient: A Case Report

Spontaneous pneumomediastinum (SPM) is a decisive complication reported to be associated with COVID-19. Here, we present a case of SPM in a COVID-19positive patient that was not caused by any iatrogenic or known reasons. At the time of admission, the patient was COVID-positive and distressed. He was immediately subjected to hematological and radiological investigations (chest X-ray, HRCT), which confirmed pneumomediastinum. The patient was hypoxic and hypotensive even after receiving ionotropic support. Considering the patient's critical condition, a mediastinal pigtail catheterization was performed instead of a thoracotomy, and the catheter was in situ for nine days. Arterial blood gas was monitored during the hospital stay, and supplementary oxygen therapy was provided accordingly. The patient subsequently recovered and was discharged. Hence, SPM in this COVID patient was treated by pigtail catheterization, and major surgical interventions were avoided.Copyright © 2023 LookUs Scientific. All rights reserved.

Successful Lung Clearing Even after Spontaneous Pneumomediastinum and COVID-19 ARDS

In severe COVID pneumonia, we have seen reports of patients suffering from spontaneous pneumomediastinum, as well as pneumothorax as a unique complication. Diffuse alveolar damage can be the etiology behind this. We report a case of a 51-year-old mountaineer female who had severe COVID pneumonia, developed air leaks, but her lung injury and scarring completely improved in 5 months.

Airleak Syndrome Like Spontaneous Subcutaneous Emphysema, Pneumomediastinum and Pneumothorax as Presenting Signs of Corona Virus Pneumonia - A Case Series

Spontaneous subcutaneous emphysema, pneumothorax, and pneumomediastinum are rare entities as the initial presentation of coronavirus infection in patients without positive pressure ventilation. This case series presents five cases of COVID-19 pneumonia who presented with alveolar air leak syndrome without prior invasive or noninvasive ventilation and high-flow nasal cannula oxygenation. Two patients presented with surgical emphysema, two with pneumothorax, and one with pneumomediastinum. This series included 30-50-year-old nonsmokers (three males and two females) with no previous history of any comorbidity and smoking who came to the emergency with symptoms such as cough, breathing difficulty, and respiratory distress. The COVID-19 infection was diagnosed by reverse transcriptase-polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2. Chest X-ray and computed tomography showed diffuse multifocal ground-glass infiltrates, interlobular septal thickening, and infiltration in all patients. Three patients had subcutaneous emphysema, two had pneumothorax and pneumomediastinum, and one had pneumomediastinum. Three patients later on required invasive mechanical ventilation. Alveolar air leak syndrome including spontaneous pneumomediastinum, pneumothorax, and subcutaneous emphysema is rarely seen as the initial presentation of coronavirus pneumonia but may develop after positive pressure ventilation.

Case Series of Pneumomediastinum and Subcutaneous Emphysema in COVID-19 Patients

Spontaneous pneumomediastinum has been reported in association with COVID-19. Pneumomediastinum could remain elusive until computed tomogra- phy is performed. Hence, we need to be vigilant even though it generally has a benign clinical course. We presented four confirmed COVID-19 cases with typical ground glass opacity on chest radiograph. All four had the computed tomography that re- vealed pneumomediastinum, pneumothorax and subcutaneous emphysema. Only one patient had pneumomediastinum after intubation. Pneumomediastinum is a devastating finding which should be picked up as early as possible and must be excluded in COVID patients whom deteriorate quickly, as adequate time may pass before any viable intervention can be done to expedite the patients' recovery. Copyright © 2022 Tehran University of Medical Sciences.

Spontaneous pneumomediastinum in Covid-19 : a case of complete resolution despite invasive positive pressure ventilation

We present the case of a 65-year-old patient who was admitted to the intensive care unit (ICU) due to Covid-19 respiratory failure. During his hospital stay, he developed a spontaneous pneumomediastinum (SP). To date, there have been few reports of SP associated with Covid-19 and even less is known about the impact of positive pressure ventilation on these patients. Our patient was first treated with high-flow nasal cannula oxygen therapy (HFNC). Because of further respiratory deterioration, he was supported with non-invasive ventilation (NIV). Later, he required intubation and ventilation with invasive positive pressure ventilation. Despite this, a complete spontaneous resolution of the pneumomediastinum was observed 13 days after the initial diagnosis. Copyright © Acta Anaesthesiologica Belgica, 2021.

Massive Spontaneous Pneumomediastinum-A Form of Presentation for Severe COVID-19 Pneumonia.

For COVID-19 pneumonia, many manifestations such as fever, dyspnea, dry cough, anosmia and tiredness have been described, but differences have been observed from person to person according to age, pulmonary function, damage and severity. In clinical practice, it has been found that patients with severe forms of infection with COVID-19 develop serious complications, including pneumomediastinum. Although two years have passed since the beginning of the pandemic with the SARS-CoV-2 virus and progress has been made in understanding the pathophysiological mechanisms underlying the COVID-19 infection, there are also unknown factors that contribute to the evolution of the disease and can lead to the emergence some complications. In this case report, we present a patient with COVID-19 infection who developed a massive spontaneous pneumomediastinum and subcutaneous emphysema during hospitalization, with no pre-existing lung pathology and no history of smoking. The patient did not get mechanical ventilation or chest trauma, but the possible cause could be severe alveolar inflammation. The CT results highlighted pneumonia in context with SARS-CoV-2 infection affecting about 50% of the pulmonary area. During hospitalization, lung lesions evolved 80% pulmonary damage associated with pneumomediastinum and subcutaneous emphysema. After three months, the patient completely recovered and the pneumomediastinum fully recovered with the complete disappearance of the lesions. Pneumomediastinum is a severe and rare complication in COVID-19 pneumonia, especially in male patients, without risk factors, and an early diagnosis can increase the chances of survival.

Spontaneous Pneumomediastinum in a 16-Year-Old Patient with SARS-CoV-2 Infection: A North-East Romanian Case.

Spontaneous pneumomediastinum (SPM) associated with SARS-CoV-2 infection is a rare condition but can represent a medical emergency. It is probably related to alveolar damage secondary to SARS-CoV-2 infection, which allows air to escape in the surrounding lung tissue. Cough and airways' barotrauma are also mentioned as contributing mechanisms. Treatment is generally conservative, but surgery may be required in severe cases. This paper presents the case of a 16-year-old girl with COVID-19-associated SPM who was treated conservatively in our department. The clinical course was favorable with resolution of respiratory symptoms and radiological (chest CT scan) image of pneumomediastinum. The patient was discharged 7 days after the confirmation of the initial SP diagnosis with appropriate treatment and recommendations for isolation. The sudden occurrence of chest pain and dyspnea should raise the suspicion of SPM in COVID-19 patients. Close surveillance and proper radiological monitoring are required in such cases. Treatment should be strictly individualized based on clinical course and radiological appearance.

ST-Segment Elevation Secondary to Spontaneous Pneumomediastinum in the Setting of COVID-19 Infection: A Case Report and Literature Review.

A 45-year-old male presented with shortness of breath, cough,and chest discomfort. He reported positive test results for coronavirus disease 2019 (COVID-19) four days prior; this was confirmed by a second test administered at the hospital. Results of a chest CT, consistent with COVID-19 pneumonia, also revealed pneumomediastinum (PM). EKG showed ST elevations in the inferior leads with no reciprocal changes. Emergent cardiac catheterization showed that he had no stenosis in his major coronary arteries. His symptoms resolved after 25 days of hospitalization and the patient was ultimately discharged. This case highlights the importance of recognizing spontaneous PM as a complication of COVID-19 along with its uncommon presentation of ST elevation in order to prevent unnecessary invasive procedures.

A Dangerous Duo: Spontaneous Pneumomediastinum and Venous Thromboembolism at Presentation in a Patient with COVID-19 Pneumonia.

Background: Coronavirus disease 2019 (Covid-19) is associated with spontaneous pneumomediastinum (SPM) predominantly in those after positive pressure ventilation (PPV) support. Additionally, many cases of venous thromboembolism (VTE) in COVID-19 patients were described. Our case is the first to describe SPM and VTE present on admission in a patient with Covid -19 pneumonia. Case report: A 53-year-old man presented to the hospital with escalating dyspnea. Two weeks prior to this visit, he had been evaluated in an ambulatory setting and was started on antibiotics and systemic steroids. In the hospital, this patient was found to be in acute hypoxic respiratory failure and was placed on noninvasive PPV. Diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was confirmed by reverse transcriptase-polymerase chain reaction (RT-PCR) test from nasopharyngeal swab specimen. Chest computed tomography (CT) scan revealed multi-lobar pulmonary emboli (PE) and subcutaneous emphysema with pneumomediastinum. The patient was managed conservatively. He never required closed invasive mechanical ventilation. Subsequent serial imaging displayed the resolution of SPM. Conclusion: The association between VTE and COVID-19 has been established. This report brings attention to SPM as an additional important complication of COVID-19, even in patients without pre-existing predisposing pathology or exposure to PPV.

SPONTANEOUS PNEUMOMEDIASTINUM IN COVID-19 INFECTION

Spontaneous pneumomediastinum is a condition, in which the presence of free air in the mediastinum is established, without previous trauma, surgery or other medical procedure. Due to its relative rarity and difficulty in establishing clinical manifestations, its diagnosis can easily be missed. Pneumomediastinum is rare in viral infections, with only single cases of patients with COVID-19 and pneumomediastinum reported in the literature. The clinical case presented by us is of a 58-year-old man with bilateral inflammatory lung changes associated with COVID-19 infection and development of spontaneous pneumomediastinum. The complication was controlled against the background of oxygen therapy, without the need for intubation and mechanical ventilation. Although pneumomediastinum is a rare complication in patients with COVID-19, there is evidence that its occurrence is a factor associated with disease exacerbation as well as an increased risk of death. Early diagnosis of pneumomediastinum enables better management of the acute respiratory failure with conservative approach, which improves the prognosis in these patients. © 2021, Central Medical Library Medical University – Sofia. All rights reserved.

Air in the Wrong Place at the Wrong Time: A Case of Pneumomediastinum and Pneumopericardium in the Setting of COVID-19 Disease.

Infection with SARS-CoV-2, commonly referred to as COVID-19 disease, has been noted to involve a systemic inflammatory reaction affecting multiple organ systems. Patients present with a spectrum of symptoms from mild to severe respiratory distress requiring supplemental oxygen and, at times, intubation and mechanical intubation. Pulmonary involvement causes diffuse alveolar wall damage leading to destruction and collapse of the alveolar walls causing air leakage and introduction of the air into the mediastinum, pericardium, and interstitial spaces. We present a case of a 71-year-old patient who presented with respiratory distress requiring supplemental oxygen with subsequent rapid decline and decompensation requiring intubation and mechanical ventilation who was found to have pneumomediastinum and pneumopericardium.

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

Spontaneous pneumomediastinum (SPM), unrelated to mechanical ventilation, has been newly described as a complication of patients with coronavirus disease (COVID-19) pneumonia without the associated risk factors. The main objective of presenting this case is to highlight a rare but important complication among patients with COVID-19 pneumonia treated only with a high-flow nasal cannula (HFNC). We aim to study the possible underlying pathophysiology of this phenomenon.

A Unique Presentation of Spontaneous Pneumomediastinum Following COVID-19 Infection.

Pneumomediastinum is a rare, life-threatening condition in which air leaks into the mediastinum. Usually, it results from a traumatic event that leads to the escape of air from the airway, lungs, or bowel into the chest cavity. Patients with underlying lung pathology or a history of invasive mechanical ventilation have an increased risk of developing a pneumomediastinum. A spontaneous pneumomediastinum (SPM) occurs in the absence of these risk factors. Patients with coronavirus disease 2019 (COVID-19) pneumonia tend to have a higher risk of developing an SPM, however, this is usually linked to mechanical ventilator use. Although rare, cases of healthy young patients with no history of underlying lung pathology or mechanical ventilator use developing an SPM are increasingly being reported. In efforts to bring more attention to this complication, we present the case of an SPM in a 40-year-old female patient with COVID-19 pneumonia and highlight the importance of close follow-up.

SPONTANEOUS PNEUMOMEDIASTINUM IN COVID-19 PATIENTS

Introduction: COVID-19 disease, thought to originate from China, is now a global pandemic. It shows a variety of pulmonary manifestations, mostly in the form of ground-glass opacities with a peripheral distribution. Less common manifestations such as pneumomediastinum have also been reported. The aim of this study is to make a contribution to the literature to be familiar with uncommon symptoms and presentations and highlight the importance of early diagnosis. Materials and methods: Patients with pneumomediastinum on computed tomography (CT) and COVID-19, which was confirmed by positive real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) test result included in the study. Patient data were collected retrospectively from medical records. Results: In 7 patients, pneumomediastinum was the initial presentation, while two were diagnosed with CT Pneumomediastinum after the COVID-19 diagnosis. All patients had mild disease, underwent conservative therapy, and no complication was observed during the follow-up period. Conclusion: In the second year of the pandemic, the disease still manifests itself with some rare pulmonary and extrapulmonary symptoms. It is crucial to be familiar with these uncommon presentations and diagnose patients at early stages.

Pneumomediastinum due to spontaneous tracheal breach in COVID-19.

Patients who have contracted coronavirus disease 2019 (COVID-19) have a wide variety of complications, many of them involving the respiratory system. One noted complication has been pneumomediastinum. The 63-year-old gentleman, in this case, had contracted COVID-19 and was admitted to the hospital for hypoxemia. He required high-flow nasal canula oxygen but did not get intubated. On day 12 of admission, the patient had a rapid hypoxemic episode after rising from a chair and fell. Diffuse airspace infiltrates were seen on chest x-ray, signifying a possible pneumomediastinum. A CT scan confirmed pneumomediastinum, and the likely mechanism was a tracheal breach just superior to the carina. This case highlights a unique mechanism as few papers have described this etiology with such clear imaging. Surgical treatment options were considered since the likely etiology could be traced to the tracheal defect, but the patient was ultimately managed conservatively with high flow nasal cannula oxygen.

Young convalescent COVID-19 pneumonia with extensive pneumomediastinum emphysema: Case report.

The development of the SARS-CoV-2 pandemic caused a common appearance of severe pulmonary complications, rarely seen as a result of the other infections. These are pneumothorax, pneumomediastinum, emphysematous bullae, cavitary lung lesions, or subcutaneous emphysema. Their formation is influenced by both-the natural course of the disease and the treatment strategy adopted.

Subcutaneous emphysema and spontaneous pneumomediastinum in non-intubated COVID-19 patient: The first case report in Syria.

The complications of covid-19 may include pneumonia, acute respiratory distress syndrome (ARDS), multi-organ failure, septic shock, and death. Subcutaneous emphysema with as a complication of covid-19 has been documented in a few cases in the medical literature as case reports. A 36-year-old patient with covid-19 complained of symptoms of fever and dyspnea with no history of trauma or smoking. After computed tomography scan and x-ray, it was found that there was Subcutaneous emphysema and spontaneous pneumomediastinum. The medical treatment of corticosteroids and intravenous anticoagulant was immediately performed to improve the patient's condition significantly. The patient was discharged with nearly full recovery. We did the following-up for the patient and the results were good. The combination of these two complication is a reality for Covid-19 patients, so a quick and accurate diagnosis and continuous follow-up should be taken into account to avoid the danger to the patient's life as a result of the formed dyspnea.

Spontaneous Pneumomediastinum: A Possible Severe Condition in SARS-CoV-2 Pneumonia.

Background Spontaneous pneumomediastinum (SP) is the presence of free air into extra-alveolar tissues within the mediastinum, without notion of trauma. This rare condition may occur as a complication of an underlying severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia. Higher rates of mechanical ventilation are reported in coronavirus disease 2019 (COVID-19) patients with pneumomediastinum. Case Description We report two cases of COVID-19 infected patients suffering from mild and severe SP and their outcome. Discussion The objective of this report is to review the literature about this condition. We discuss about the pathological pathways underlying this complication and how it reflects the severity of COVID-19 pneumonia. Conclusion Currently, it remains unclear if SP in SARS-CoV-2 pneumonia is a potential predictor of disease worsening, for it does not seem to be related with a higher rate of mortality.

Spontaneous pneumomediastinum as an unusual complication of COVID-19 pneumonia.

Spontaneous pneumomediastinum is to consider in COVID-19 patients with progressive respiratory deterioration. It possibly reflects extensive alveolar injury and prompts close monitoring. Although generally self-limiting, it could be lifeߚthreatening.

COVID-19-Associated Pneumomediastinum: An Emerging Clinical Presentation.

Recent publications have suggested an association between coronavirus disease 2019 (COVID-19) pneumonitis and pneumomediastinum. The association has been linked to the frequent use of mechanical ventilation in these patients; however, there have also been increasing reports of spontaneous pneumomediastinum in the absence of mechanical ventilation. These reports suggest a direct association between COVID-19 pneumonitis and increased alveolar fragility. In this report, we present a case of a spontaneous mediastinum in a 64-year-old male patient with COVID-19 without any history of mechanical ventilation.