Angiocatheter Decompression on a Covid-19 Patient with severe Pneumonia, Pneumothorax, and Subcutaneous Emphysema.

BACKGROUND: A novel coronavirus, currently known as Severe Acute Respiratory Syndrome Coronavirus 2, causes Coronavirus disease 2019 (Covid-19). Its most significant complication is a kind of pneumonia known as of 2019 New Coronavirus-Infected Pneumonia (NCIP). Covid-19 pneumonia can have unusual complications that affect both lungs in a widespread manner. Acute lung damage and Acute Respiratory Distress Syndrome (ARDS) are typical in severe Covid-19 cases. Several potential risk factors cause the pneumonia associated with this disease, such as age over 65, diabetes, hypertension, chronic obstructive pulmonary disease, immunosuppression, and pregnancy. Furthermore, various laboratory markers like high levels of C-reactive protein (CRP), D-dimers, ferritin, interleukin-6 (IL-6), and LDH, as well as a low lymphocyte and thrombocyte count, have been linked to increased disease severity and a poor prognosis. METHODS: In this study, we present a case of a 45-year-old patient with a rare evolution of the disease, who made a full recovery against all odds. We highlight the atypical presentation of Covid-19 in this patient, who developed some unusual complications, such as pneumonia, pneumothorax, pneumomediastinum, and subcutaneous emphysema. RESULTS: There is a scarcity of information on patient-related variables linked to pneumothorax in severely sick Covid-19 patients. This study adds to the existing research, reinforcing that spontaneous pneumothorax can be caused by the infection itself, in addition to ventilator-induced trauma in mechanically ventilated patients. CONCLUSIONS: We conclude that patients with Covid-19 pneumonia may develop a more robust and systemic illness characterized by acute lung injury, acute respiratory distress syndrome (ARDS), shock, coagulopathy, and nu¬merous organ dysfunctions, all of which are linked with a high risk of death.

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.

Cervico-Thoracic Air Collections in COVID-19 Pneumonia Patients - Our Experience and Brief Review.

Introduction: Abstract COVID-19 (Coronavirus-19 disease), a new clinical entity caused by SARS-COV-2 infection, could explain the physiopathology of cervicothoracic air collections (pneumothorax, pneumomediastinum, and subcutaneous emphysema). Material and Methods: We conducted an 8-months retrospective analysis of a single-center SARS-CoV-2 cases associating pneumothorax, pneumomediastinum, and subcutaneous emphysema, either alone or combined. Results: All non-intubated patients with the complications cited above had a favorable outcome after pleural drainage, percutaneous drainage, and/or conservative treatment, while the intubated patients, with multiple comorbidities, have had an unfavorable outcome, regardless the chosen treatment. Pleural drainage was used for pneumothorax cases; pneumomediastinum with subcutaneous emphysema required insertion of subcutaneous needles or angio-catheters with manual decompressive massage. Conservative methods of treatment were used for patients with pneumomediastinum and medium or severe respiratory disfunction. Conclusions: Etiopathogenic classification of pneumothorax should include SARS-CoV-2 infection as a possible cause of secondary spontaneous pneumothorax due to COVID-19 pneumonia. Survival rate after the occurrence of these complications was small (18,75%), 4 of the patients were cured, 2 had a favorable outcome and 26 have died. Pleural drainage which is mandatory to do for patients with pneumothorax complication in COVID -19 pneumonia, doesn't change the prognosis for those with severe affecting lungs, because the prolonged ventilation and the other comorbidities have led to death in most of these cases.

Tracheomediastinal emphysema after tracheostomy in a post-COVID-19 patient: a case report.

OBJECTIVE: There are no reports of tracheomediastinal fistula development after tracheostomy. CASE REPORT: A 72-year-old female patient with post acute COVID-19 was transferred to our intensive care unit. After two unsuccessful weaning attempts, a tracheostomy was performed at hospitalization on day 32. The patient's body mass index was 35 kg/m2 and she had a narrow neck anatomy. A percutaneous tracheostomy was performed using the Griggs method without any problems. Pneumothorax, pneumomediastinum, subcutaneous emphysema, and hemorrhage were not observed. Twenty-two days after the tracheostomy, the patient developed subcutaneous emphysema and experienced a sudden decrease in oxygen saturation. Bedside anterior-posterior chest X-ray did not detect pneumothorax and a tracheoesophageal fistula was found via esophageal endoscopy. A tracheomediastinal fistula was observed just below the cannula distal end via computed tomography. CONCLUSIONS: There are multiple reasons why a tracheomediastinal fistula could develop after tracheostomy. Therefore, this condition should be considered in cases of sudden subcutaneous emphysema and oxygen deterioration following tracheostomy.

Case Of Pneumomediastinum And Surgical Emphysema In A Patient With Covid-19 Pneumonia, On Cpap.

An unusual case of a 35-year-old woman with COVID-19 pneumonia who suddenly desaturated while on continuous positive airway pressure leading to pneumomediastinum and surgical emphysema thereby requiring ventilatory support in intensive therapy unit. It is unclear from history and clinical assessment; whether this complication was directly related to COVID-19 pneumonia and it worsened with the initiation of CPAP, OR it was a direct complication of CPAP.