Chest Tightness with Cycling Turned Out To Be Pneumomediastinum.

BACKGROUND Pneumomediastinum, or mediastinal emphysema, means air present inside the mediastinum. It usually presents with symptoms of chest pain and shortness of breath. Examination can be significant for crepitus along the neck area. There are many risk factors associated with pneumomediastinum, including asthma and COVID-19. Most cases of pneumomediastinum improve with conservative management, and surgery (mediastinotomy) is reserved for complicated cases with tension pneumomediastinum. CASE REPORT This is the case of a 23-year-old man who presented with chest tightness after 3.5 h of cycling. The patient did have a prior history of clinically stable asthma, with no recent exacerbation, and denied any other associative factors. Imaging was significant for pneumomediastinum. The patient was admitted for observation in the hospital and treated with supportive care, without any surgical intervention. The patient had appropriate improvement in his symptoms in 24 h. Repeat imaging showed improvement in the pneumomediastinum, and the patient was discharged to outpatient follow-up. CONCLUSIONS Our case presents a unique link between cycling and pneumomediastinum. Prolonged cycling may emerge as a risk factor for this complication. People with a previous history of pneumomediastinum should be careful to review other risk factors prior to planning long-distance bicycling. Physicians need to keep this differential diagnosis in mind when encountering a patient with similar symptoms so that a timely diagnosis is made.

Secondary Complications in COVID-19 Patients: A Case Series.

INTRODUCTION: Coronavirus SARS-CoV-2, the causative agent of COVID-19, primarily causes a respiratory tract infection that is not limited to respiratory distress syndrome, but it is also implicated in other body systems. Systemic complications were reported due to an exaggerated inflammatory response, which involves severe alveolar damage in the lungs and exacerbates the hypercoagulation that leads to venous thrombosis, ischemic attack, vascular dysfunction and infarction of visceral abdominal organs. Some complications are related to anticoagulant drugs that are administrated to stabilize hypercoagulability, but increase the risk of bleeding, hematoma and hemorrhage. The aim of this study is to report the diagnostic role of CT in the early diagnosis and management of patients with severe COVID-19 complications through the most interesting cases in our experience. MATERIAL AND METHODS: The retrospective analysis of patients studied for COVID-19 in our institution and hospitals, which are part of the university training network, was performed. CASES: Pneumomediastinum, cortical kidney necrosis, splenic infarction, cerebral ischemic stroke, thrombosis of the lower limb and hematomas are the most major complications that are reviewed in this study. CONCLUSIONS: Since the onset of the COVID-19 pandemic, the CT imaging modality with its high sensitivity and specificity remains the preferred imaging choice to diagnose early the different complications associated with COVID-19, such as thrombosis, ischemic stroke, infarction and pneumomediastinum, and their management, which significantly improved the outcomes.

Acute tracheal tear - A potential cause of spontaneous pneumomediastinum in patients with COVID-19.

Spontaneous pneumomediastinum following prolonged periods of severe coughing should raise the suspicion of tracheal rupture in COVID-19 patients.

Bedside Mediastinotomy for Tension Pneumomediastinum With Tamponade in COVID-19.

Tension pneumomediastinum is a rare but life-threatening cause of tamponade. Mechanical ventilation is a described source of tension pneumomediastinum. Here, we present a case of a 72-year-old man who developed cardiovascular collapse from tension pneumomediastinum in the setting of coronavirus disease 2019-related acute respiratory distress syndrome. We successfully performed bedside mediastinotomy and mediastinal tube placement under local anesthetic to alleviate his hemodynamic instability. Bedside mediastinotomy can be used to relieve tension pneumomediastinum in this setting.

Broadening the differential: pneumomediastinum and COVID-19 infection.

The novel coronavirus (COVID-19) has emerged as a new pathogen responsible for an atypical viral pneumonia, with severe cases progressing to an acute respiratory distress syndrome. In our practice, we have observed patients admitted with COVID-19 pneumonia developing worsening hypoxaemic respiratory failure prompting the need for urgent endotracheal intubation. Here, we present a case of a patient admitted with severe COVID-19 pneumonia who required continuous positive airway pressure support following acute deterioration. However, with the patient requiring an increasing fraction of inspired oxygen (FiO2), a prompt CT pulmonary angiogram scan was performed to exclude an acute pulmonary embolism. Surprisingly, this revealed a pneumomediastinum. Following a brief admission to the intensive care unit, the patient made a full recovery and was discharged 18 days post admission.