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1.
Gac Med Mex ; 157(1): 110-114, 2021.
Article in English | MEDLINE | ID: covidwho-1268461

ABSTRACT

Spontaneous pneumomediastinum is defined as the presence of free air within the mediastinum without an apparent cause such as chest trauma. It is a benign, self-limiting condition that is conservatively treated. Clinical diagnosis is based on two symptoms: chest pain and dyspnea; and on a particular sign: subcutaneous emphysema. It has been reported in patients with influenza A (H1N1) and severe acute respiratory syndrome; however, it has been rarely observed in COVID-19 patients. In this work, we describe six male patients with COVID-19, aged between 27 and 82 years, who presented with spontaneous pneumomediastinum and subcutaneous emphysema; both conditions were completely resorbed with conservative management.


El neumomediastino espontáneo es la presencia de aire libre en el mediastino sin el antecedente de alguna causa como trauma de tórax. Es una condición benigna autolimitada que se trata en forma conservadora. El diagnóstico clínico se basa en dos síntomas: dolor torácico y disnea; y en un signo en particular: enfisema subcutáneo. Ha sido reportado en pacientes con influenza A (H1N1) y síndrome respiratorio agudo grave; sin embargo, ha sido raramente observado en pacientes con COVID-19. En este trabajo describimos seis pacientes del sexo masculino con COVID-19, con edades entre 27 y 82 años, que presentaron neumomediastino espontáneo y enfisema subcutáneo; ambos se reabsorbieron totalmente con manejo conservador.


Subject(s)
COVID-19/complications , Mediastinal Emphysema/etiology , Subcutaneous Emphysema/etiology , Adult , Aged, 80 and over , Humans , Male , Middle Aged
2.
Epidemiol Infect ; 149: e137, 2021 06 08.
Article in English | MEDLINE | ID: covidwho-1260912

ABSTRACT

The novel coronavirus identified as severe acute respiratory syndrome-coronavirus-2 causes acute respiratory distress syndrome (ARDS). Our aim in this study is to assess the incidence of life-threatening complications like pneumothorax, haemothorax, pneumomediastinum and subcutaneous emphysema, probable risk factors and effect on mortality in coronavirus disease-2019 (COVID-19) ARDS patients treated with mechanical ventilation (MV). Data from 96 adult patients admitted to the intensive care unit with COVID-19 ARDS diagnosis from 11 March to 31 July 2020 were retrospectively assessed. A total of 75 patients abiding by the study criteria were divided into two groups as the group developing ventilator-related barotrauma (BG) (N = 10) and the group not developing ventilator-related barotrauma (NBG) (N = 65). In 10 patients (13%), barotrauma findings occurred 22 ± 3.6 days after the onset of symptoms. The mortality rate was 40% in the BG-group, while it was 29% in the NBG-group with no statistical difference identified. The BG-group had longer intensive care admission duration, duration of time in prone position and total MV duration, with higher max positive end-expiratory pressure (PEEP) levels and lower min pO2/FiO2 levels. The peak lactate dehydrogenase levels in blood were higher by statistically significant level in the BG-group (P < 0.05). The contribution of MV to alveolar injury caused by infection in COVID-19 ARDS patients may cause more frequent barotrauma compared to classic ARDS and this situation significantly increases the MV and intensive care admission durations of patients. In terms of reducing mortality and morbidity in these patients, MV treatment should be carefully maintained within the framework of lung-protective strategies and the studies researching barotrauma pathophysiology should be increased.


Subject(s)
COVID-19/complications , Hemothorax/etiology , Mediastinal Emphysema/etiology , Pneumothorax/etiology , Respiratory Distress Syndrome/complications , Subcutaneous Emphysema/etiology , Adult , Aged , Barotrauma/epidemiology , Barotrauma/etiology , COVID-19/epidemiology , COVID-19/therapy , Female , Hemothorax/epidemiology , Hospital Mortality , Hospitalization , Humans , Intensive Care Units , Lung Injury/epidemiology , Lung Injury/etiology , Male , Mediastinal Emphysema/epidemiology , Middle Aged , Pneumothorax/epidemiology , Respiration, Artificial/adverse effects , Respiratory Distress Syndrome/epidemiology , Respiratory Distress Syndrome/therapy , Retrospective Studies , Risk Factors , SARS-CoV-2 , Subcutaneous Emphysema/epidemiology
5.
J Coll Physicians Surg Pak ; 31(2): 132-137, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1110941

ABSTRACT

OBJECTIVE: To determine the risk factors for spontaneous pneumomediastinum (SPM), its clinical course and effect on prognosis in patients with Coronavirus disease-19 (COVID-19) pneumonia. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Kayseri City Training and Research Hospital, Turkey, from April  to September 2020. METHODOLOGY: All COVID-19 patients' clinical, laboratory, and radiologic characteristics, as well as treatment outcome data, were obtained through medical record extraction. Group A had 50 patients (22 men and 28 women) without SPM, and Group B had 20 patients (10 men and 10 women) with SPM. RESULTS: Considering the accompanying comorbidities, the frequencies of asthma and inhaler-use was significantly higher in Group B than in Group A (p <0.05). In the CT evaluation at presentation, the rate of involvement of all five lobes of the lung in Group B was significantly higher than in Group A. Rates of tube thoracostomy, mechanical ventilator requirement, length of stay in hospital, and exitus were significantly higher in Group B than in Group A (p <0.05). CONCLUSION: SPM development in a patient with COVID-19 pneumonia is a sign that the prognosis will not be good, and these patients need a more aggressive treatment. Key Words: Spontaneous pneumomediastinum, COVID-19, Pneumothorax, Real-time polymerase chain reaction, Subcutaneous emphysema.


Subject(s)
COVID-19/complications , Lung/diagnostic imaging , Mediastinal Emphysema/etiology , Adult , Aged , COVID-19/diagnostic imaging , Chest Tubes , Female , Humans , Male , Mediastinal Emphysema/diagnosis , Mediastinal Emphysema/diagnostic imaging , Middle Aged , Pandemics , Pneumothorax/diagnostic imaging , Pneumothorax/virology , Prognosis , Real-Time Polymerase Chain Reaction , SARS-CoV-2 , Subcutaneous Emphysema/diagnostic imaging , Subcutaneous Emphysema/etiology , Thoracostomy , Tomography, X-Ray Computed
6.
Epidemiol Infect ; 149: e37, 2021 01 20.
Article in English | MEDLINE | ID: covidwho-1072077

ABSTRACT

Since December 2019, the clinical symptoms of coronavirus disease 2019 (COVID-19) and its complications are evolving. As the number of COVID patients requiring positive pressure ventilation is increasing, so is the incidence of subcutaneous emphysema (SE). We report 10 patients of COVID-19, with SE and pneumomediastinum. The mean age of the patients was 59 ± 8 years (range, 23-75). Majority of them were men (80%), and common symptoms were dyspnoea (100%), fever (80%) and cough (80%). None of them had any underlying lung disorder. All patients had acute respiratory distress syndrome on admission, with a median PaO2/FiO2 ratio of 122.5. Eight out of ten patients had spontaneous pneumomediastinum on their initial chest x-ray in the emergency department. The median duration of assisted ventilation before the development of SE was 5.5 days (interquartile range, 5-10 days). The highest positive end-expiratory pressure (PEEP) was 10 cmH2O for patients recieving invasive mechanical ventilation, while 8 cmH2O was the average PEEP in patients who had developed subcutaneous emphysema on non-invasive ventilation. All patients received corticosteroids while six also received tocilizumab, and seven received convalescent plasma therapy, respectively. Seven patients died during their hospital stay. All patients either survivor or non-survivor had prolonged hospital stay with an average of 14 days (range 8-25 days). Our findings suggest that it is lung damage secondary to inflammatory response due to COVID-19 triggered by the use of positive pressure ventilation which resulted in this complication. We conclude that the development of spontaneous pneumomediastinum and SE whenever present, is associated with poor outcome in critically ill COVID-19 ARDS patients.


Subject(s)
COVID-19/complications , COVID-19/epidemiology , Mediastinal Emphysema/etiology , SARS-CoV-2 , Subcutaneous Emphysema/etiology , Adult , Aged , Female , Humans , Male , Mediastinal Emphysema/epidemiology , Middle Aged , Pakistan/epidemiology , Subcutaneous Emphysema/epidemiology , Tertiary Care Centers , Young Adult
7.
Tuberk Toraks ; 68(4): 437-443, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1067904

ABSTRACT

Barotrauma is a commonly reported complication in critically ill patients with ARDS caused by different etiologies, it's rate is reported to be around %10. Pneumothorax/pneumomediastinum in COVID-19 patients seem to be more common and have different clinical characteristics. Here we report 9 patients who had pneumothorax and/or pneumomediastinum during their stay in the ICU. Patients who were admitted to ICU between March 2020 and December 2020, were reviewed for presence of pneumothorax, pneumomediastinum and subcutaneous emphysema during their ICU stay. Demographic characteristics, mechanical ventilation settings, documented ventilation parameters, outcomes were studied. A total of 161 patients were admitted to ICU during the study period, 96 were invasively ventilated. Nine patients had developed pneumothorax, pneumomediastinum and/or subcutaneous emphysema during their admission. Five of them were men and median age was 66.6 years. All patients were intubated and mechanically ventilated. All patients were managed conservatively. One patient was discharged from ICU, the others were lost due to other complications related to COVID-19. Upon detection of pneumothorax and/or mediastinum all patients were managed conservatively by limiting their PEEP and maximum inspiratory pressures and were followed by daily chest X-rays (CXR) for detection of any progress. None of the patients showed increase in size of their pneumothorax and/or pneumomediastinum. Hemodynamically instability due to pneumothorax and/or pneumomediastinum was not observed in any of the patients. Tension pneumothorax was not observed in any of the patients. Most common reason for death was sepsis due to secondary bacterial infections. Acute deterioration with rapid oxygen desaturation or palpation of crepitation over thorax and neck in a COVID-19 patient should prompt a search for pneumothorax or pneumomediastinum. Conservative management may be an option as long as the patients are stable.


Subject(s)
COVID-19 , Respiration, Artificial/adverse effects , SARS-CoV-2 , Aged , Aged, 80 and over , Diagnosis, Differential , Female , Hospitalization , Humans , Male , Mediastinal Emphysema/diagnosis , Mediastinal Emphysema/etiology , Middle Aged , Pneumothorax/diagnosis , Pneumothorax/etiology , Subcutaneous Emphysema/diagnosis , Subcutaneous Emphysema/etiology
8.
Monaldi Arch Chest Dis ; 90(4)2020 Sep 18.
Article in English | MEDLINE | ID: covidwho-1060341

ABSTRACT

The coronavirus disease 2019 (COVID-19) is a recent pandemic that affected more than 5 million people worldwide. Chest high resolution computed tomography (HRCT) is an essential tool in diagnosis and management of the disease. Pulmonary parenchymal opacity is a typical sign of the disease, but not the only one. Pneumothorax, pneumomediastinum, bronchiectasis and cysts are probably underrated complications of COVID-19 that can worsen prognosis, in terms of prolonged hospitalization and need of oxygen therapy. In our single center case series, we outline four different manifestations of pneumothorax, pneumomediastinum and cysts in hospitalized patients with COVID-19 pneumonia.


Subject(s)
Bronchiectasis/diagnostic imaging , Coronavirus Infections/diagnostic imaging , Cysts/diagnostic imaging , Lung/diagnostic imaging , Mediastinal Emphysema/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Pneumothorax/diagnostic imaging , Adult , Betacoronavirus , Bronchiectasis/etiology , COVID-19 , Coronavirus Infections/complications , Cysts/etiology , Humans , Italy , Lung Diseases/diagnostic imaging , Lung Diseases/etiology , Male , Mediastinal Emphysema/etiology , Middle Aged , Pandemics , Pneumonia, Viral/complications , Pneumothorax/etiology , SARS-CoV-2 , Subcutaneous Emphysema/diagnostic imaging , Subcutaneous Emphysema/etiology , Tomography, X-Ray Computed
9.
Am J Case Rep ; 22: e927954, 2021 Jan 27.
Article in English | MEDLINE | ID: covidwho-1050748

ABSTRACT

BACKGROUND Invasive mechanical ventilation can cause pulmonary barotrauma due to elevated transpulmonary pressure and alveolar rupture. A significant proportion of COVID-19 patients with acute respiratory distress syndrome (ARDS) will require mechanical ventilation. We present 2 interesting cases that demonstrate the possibility of COVID-19-associated ARDS manifesting with pulmonary barotrauma at acceptable ventilatory pressures. CASE REPORT The first patient was a 71-year-old man who was intubated and placed on mechanical ventilation due to hypoxemic respiratory failure from SARS-CoV-2 infection. His partial pressure of O2 to fraction of inspired oxygen ratio (PaO2/FiO2) was 156. He developed subcutaneous emphysema (SE) and pneumomediastinum on day 5 of mechanical ventilation at ventilatory settings of positive end-expiratory pressure (PEEP) ≤15 cmH2O, plateau pressure (Pplat) ≤25 cmH2O and pulmonary inspiratory pressure (PIP) ≤30 cmH2O. He was managed with 'blow-hole' incisions, with subsequent clinical resolution of subcutaneous emphysema. The second patient was a 58-year-old woman who was also mechanically ventilated due to hypoxemic respiratory failure from COVID-19, with PaO2/FiO2 of 81. She developed extensive SE with pneumomediastinum and pneumothorax while on mechanical ventilation settings PEEP 13 cmH2O and PIP 28 cmH2O, Pplat 18 cmH2O, and FiO2 90%. SE was managed with blow-hole incisions and pneumothorax with chest tube. CONCLUSIONS Clinicians should be aware of pulmonary barotrauma as a possible complication of COVID-19 pulmonary disease, even at low ventilatory pressures.


Subject(s)
Barotrauma/etiology , COVID-19/complications , Lung Injury/etiology , Respiration, Artificial/adverse effects , Aged , Female , Humans , Male , Mediastinal Emphysema/etiology , Middle Aged , Respiratory Distress Syndrome/therapy , Respiratory Distress Syndrome/virology , Subcutaneous Emphysema/etiology
10.
Clin Imaging ; 76: 74-76, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1030862

ABSTRACT

COVID-19 is a newly emerging disease with high mortality among the elderly and patients with underlying medical conditions. We report the case of confirmed COVID-19 infection complicated with pneumomediastinum.


Subject(s)
COVID-19 , Mediastinal Emphysema , Subcutaneous Emphysema , Adult , Aged , Humans , Male , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/etiology , Pandemics , SARS-CoV-2 , Subcutaneous Emphysema/diagnostic imaging , Subcutaneous Emphysema/etiology
11.
Mod Rheumatol Case Rep ; 5(1): 101-107, 2021 01.
Article in English | MEDLINE | ID: covidwho-917630

ABSTRACT

Anti-melanoma differentiation-associated gene 5 juvenile dermatomyositis (anti-MDA5 JDM) is associated with high risk of developing rapidly progressive interstitial lung disease (RP-ILD). Here we report an 11-year-old girl with anti-MDA5 JDM and RP-ILD which led to a fatal outcome, further aggravated by SARS-CoV-2 infection. She was referred to our hospital after being diagnosed with anti-MDA5 JDM and respiratory failure due to RP-ILD. On admission, fibrobronchoscopy with bronchoalveolar lavage (BAL) revealed Pneumocystis jirovecii infection so treatment with intravenous trimethoprim-sulfamethoxazole was initiated. Due to RP-ILD worsening, immunosuppressive therapy was intensified using methylprednisolone pulses, cyclophosphamide, tofacitinib and intravenous immunoglobulin without response. She developed severe hypoxemic respiratory failure, pneumomediastinum and pneumothorax, further complicated with severe RP-ILD and cervical subcutaneous emphysema. Three real-time RT-PCR for SARS-CoV-2 were made with a negative result. In addition, she was complicated with a secondary hemophagocytic lymphohistiocytosis and a fourth real-time PCR for SARS-CoV-2 performed in BAS sample was positive. Despite aggressive treatment of RP-ILD due to anti-MDA5 JDM, there was no improvement of respiratory failure in the following days and patient developed refractory septic shock and died. Anti-MDA5 JDM patients with RP-ILD have a poor prognosis with a high mortality rate. For this reason, intensive immunosuppressive therapy is essential including the use of promising drugs such as tofacitinib. COVID-19 in children with underlying health conditions like anti-MDA5 JDM may still be at risk for disease and severe complications.


Subject(s)
COVID-19/complications , Dermatomyositis/complications , Immunosuppressive Agents/therapeutic use , Lung Diseases, Interstitial/complications , Lymphohistiocytosis, Hemophagocytic/etiology , Pneumonia, Pneumocystis/complications , Adenosine Monophosphate/analogs & derivatives , Adenosine Monophosphate/therapeutic use , Alanine/analogs & derivatives , Alanine/therapeutic use , Anti-Bacterial Agents/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , Antiviral Agents/therapeutic use , Autoantibodies/immunology , Bronchoscopy , COVID-19/therapy , COVID-19 Nucleic Acid Testing , Child , Cyclophosphamide/therapeutic use , Dermatomyositis/drug therapy , Dermatomyositis/immunology , Disease Progression , Fatal Outcome , Female , Humans , Hydroxychloroquine/therapeutic use , Immunocompromised Host , Immunoglobulins, Intravenous/therapeutic use , Immunologic Factors/therapeutic use , Interferon-Induced Helicase, IFIH1/immunology , Lung/diagnostic imaging , Lung Diseases, Interstitial/diagnostic imaging , Lung Diseases, Interstitial/immunology , Lung Diseases, Interstitial/therapy , Lymphohistiocytosis, Hemophagocytic/immunology , Mediastinal Emphysema/etiology , Methylprednisolone/therapeutic use , Piperidines/therapeutic use , Pneumonia, Pneumocystis/immunology , Pneumothorax/etiology , Pyrimidines/therapeutic use , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , Shock, Septic/etiology , Subcutaneous Emphysema/etiology , Tomography, X-Ray Computed , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use
12.
Adv Respir Med ; 88(5): 466-467, 2020.
Article in English | MEDLINE | ID: covidwho-908390

ABSTRACT

Pneumomediastinum is an uncommon but well recognized complication of both invasive and non-invasive mechanical ventilation. Spontaneous pneumomediastinum has been observed in association with a variety of structural lung diseases including severe interstitial disorders. More recently it has been reported complicating the course of COVID-19 pneumonia. In the present report we describe a case of pneumomediastinum associated with subcutaneous emphysema in a patient with severe respiratory failure due to extensive interstitial pneumoniae correlated to SARS-CoV-2 infection which necessitated non-invasive ventilatory support. Prompt recognition is required during ventilatory support as it may promote its progression. Further data are needed in order to identify the mechanisms, frequency, risk factors and prognostic role of this rare complication of the clinical course of COVID-19.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Mediastinal Emphysema/etiology , Pneumonia, Viral/therapy , Respiration, Artificial/adverse effects , Subcutaneous Emphysema/diagnostic imaging , Subcutaneous Emphysema/etiology , COVID-19 , Coronavirus Infections/complications , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/complications , SARS-CoV-2 , Subcutaneous Emphysema/therapy , Tomography, X-Ray Computed
14.
Ann Thorac Surg ; 110(5): e417-e419, 2020 11.
Article in English | MEDLINE | ID: covidwho-884669

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 disease 2019 (COVID-19) has rapidly spread worldwide since December 2019. An acute respiratory distress syndrome develops in a relevant rate of patients, who require hospitalization. Among them, a nonnegligible rate of 9.8% to 15.2% of patients requires tracheal intubation for invasive ventilation. We report the case of a pneumomediastinum and subcutaneous emphysema developing in a COVID-19 patient secondary to postintubation tracheal injury. The management of COVID-19 patients can be challenging due to the risk of disease transmission to caregivers and epidemic spread. We performed a bedside tracheal injury surgical repair, after failure of conservative management, with resolution of pneumomediastinum and subcutaneous emphysema and improvement of the patient's conditions.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Intubation, Intratracheal/adverse effects , Mediastinal Emphysema/surgery , Pneumonia, Viral/therapy , Subcutaneous Emphysema/surgery , Thoracic Surgical Procedures/methods , Trachea/injuries , Aged , COVID-19 , Coronavirus Infections/epidemiology , Humans , Male , Mediastinal Emphysema/diagnosis , Mediastinal Emphysema/etiology , Neck , Pandemics , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Subcutaneous Emphysema/diagnosis , Subcutaneous Emphysema/etiology , Tomography, X-Ray Computed
15.
J Cardiothorac Surg ; 15(1): 301, 2020 Oct 07.
Article in English | MEDLINE | ID: covidwho-835855

ABSTRACT

BACKGROUND: Spontaneous pneumomediastinum unrelated to mechanical ventilation is a newly described complication of COVID-19 pneumonia. The objective of this case presentation is to highlight an important complication and to explore potential predisposing risk factors and possible underlying pathophysiology of this phenomenon. CASE PRESENTATION: We present two patients with COVID-19 pneumonia complicated by spontaneous pneumomediastinum, pneumopericardium, pneumothorax and subcutaneous emphysema without positive pressure ventilation. Both patients had multiple comorbidities, received a combination of antibiotics, steroids and supportive oxygen therapy, and underwent routine laboratory workup. Both patients then developed spontaneous pneumomediastinum and ultimately required intubation and mechanical ventilation, which proved to be challenging to manage. CONCLUSIONS: Spontaneous pneumomediastinum is a serious complication of COVID-19 pneumonia, of which clinicians should be aware. Further studies are needed to determine risk factors and laboratory data predictive of development of spontaneous pneumomediastinum in COVID-19 pneumonia.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Mediastinal Emphysema/etiology , Pneumonia, Viral/complications , Pneumopericardium/etiology , Pneumothorax/etiology , Subcutaneous Emphysema/etiology , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Female , Humans , Intermittent Positive-Pressure Ventilation/methods , Male , Mediastinal Emphysema/diagnosis , Mediastinal Emphysema/therapy , Middle Aged , Oxygen Inhalation Therapy/methods , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Pneumopericardium/diagnosis , Pneumothorax/diagnosis , Pneumothorax/therapy , Radiography, Thoracic , SARS-CoV-2 , Subcutaneous Emphysema/diagnosis , Tomography, X-Ray Computed
16.
Clin Imaging ; 67: 207-213, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-733899

ABSTRACT

PURPOSE: We describe the presenting characteristics and hospital course of 11 novel coronavirus (COVID-19) patients who developed spontaneous subcutaneous emphysema (SE) with or without pneumomediastinum (SPM) in the absence of prior mechanical ventilation. MATERIALS AND METHODS: A total of 11 non-intubated COVID-19 patients (8 male and 3 female, median age 61 years) developed SE and SPM between March 15 and April 30, 2020 at a multi-center urban health system in New York City. Demographics (age, gender, smoking status, comorbid conditions, and body-mass index), clinical variables (temperature, oxygen saturation, and symptoms), and laboratory values (white blood cell count, C-reactive protein, D-dimer, and peak interleukin-6) were collected. Chest radiography (CXR) and computed tomography (CT) were analyzed for SE, SPM, and pneumothorax by a board-certified cardiothoracic-fellowship trained radiologist. RESULTS: Eleven non-intubated patients developed SE, 36% (4/11) of whom had SE on their initial CXR. Concomitant SPM was apparent in 91% (10/11) of patients, and 45% (5/11) also developed pneumothorax. Patients developed SE on average 13.3 days (SD: 6.3) following symptom onset. No patients reported a history of smoking. The most common comorbidities included hypertension (6/11), diabetes mellitus (5/11), asthma (3/11), dyslipidemia (3/11), and renal disease (2/11). Four (36%) patients expired during hospitalization. CONCLUSION: SE and SPM were observed in a cohort of 11 non-intubated COVID-19 patients without any known cause or history of invasive ventilation. Further investigation is required to elucidate the underlying mechanism in this patient population.


Subject(s)
Coronavirus Infections/complications , Mediastinal Emphysema/etiology , Pneumonia, Viral/complications , Subcutaneous Emphysema/etiology , Adult , Aged , Aged, 80 and over , Betacoronavirus , COVID-19 , Comorbidity , Coronavirus Infections/virology , Female , Fibrin Fibrinogen Degradation Products/metabolism , Hospitalization , Humans , Male , Mediastinal Emphysema/epidemiology , Middle Aged , Pandemics , Pneumonia, Viral/virology , Pneumothorax/epidemiology , Pneumothorax/etiology , Respiration, Artificial/adverse effects , SARS-CoV-2 , Subcutaneous Emphysema/epidemiology , Tomography, X-Ray Computed/methods
18.
Am J Case Rep ; 21: e925557, 2020 Jul 24.
Article in English | MEDLINE | ID: covidwho-675744

ABSTRACT

BACKGROUND Novel Coronavirus 2019 (COVID-19) has been in the spotlight since the first cases were reported in December 2019. COVID-19 has been found to cause severe acute respiratory distress syndrome and, more uncommonly, subcutaneous emphysema and pneumomediastinum. We present a case series of 3 patients with COVID-19 infection managed in the Intensive Care Unit and found to have subcutaneous emphysema and pneumomediastinum on chest imaging. CASE REPORT We present a case series of 3 men, ages 36, 47, and 78 years, diagnosed with COVID-19 via RT-PCR, found to have severe acute respiratory distress syndrome, and managed in the Intensive Care Unit. Two patients described in this case series were mechanically ventilated on low positive end-expiratory pressures and developed subcutaneous emphysema and pneumomediastinum on chest imaging, and 1 patient developed subcutaneous emphysema prior to intubation. Each of these patients had a more eventful hospital course and worse outcomes than most COVID-19 infected patients. CONCLUSIONS Subcutaneous emphysema and pneumomediastinum in COVID-19 patients have been rarely reported and is poorly understood. In our institution, we have found the diagnosis of subcutaneous emphysema and pneumomediastinum in COVID-19 patients is associated with unfavorable outcomes and worse prognosis.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Mediastinal Emphysema/etiology , Pneumonia, Viral/complications , Subcutaneous Emphysema/etiology , Adult , Aged , COVID-19 , Humans , Male , Mediastinal Emphysema/diagnosis , Middle Aged , Pandemics , Prognosis , SARS-CoV-2 , Subcutaneous Emphysema/diagnosis , Tomography, X-Ray Computed
19.
Medicine (Baltimore) ; 99(20): e20208, 2020 May.
Article in English | MEDLINE | ID: covidwho-344693

ABSTRACT

INTRODUCTION: Since the end of 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has affected more than 1,000,000 population in the world. Subcutaneous emphysema and pneumothorax are uncommon complications of SARS-CoV-2 pneumonia. Herein, we describe a fatal case of SARS-CoV-2 pneumonia with subcutaneous emphysema and pneumothorax. PATIENT CONCERNS: Subcutaneous emphysema was found in neck, bilateral chest walls, abdomen wall, groin area, and scrotum of a 67-year-old man. Extensive air-space opacities, subcutaneous emphysema and a small amount of pneumothorax were found in his chest X-ray scan. Echocardiography showed left ventricular enlargement with ejection fraction 20%. DIAGNOSIS: This resident of Wuhan with laboratory-confirmed SARS-CoV-2 infection had chronic pulmonary and cardiac diseases. Liver dysfunction, myocardial injury, and coagulation disorder were suggested by laboratory findings. Pneumonia, subcutaneous emphysema, and pneumothorax were confirmed with chest X-ray. Heart failure was revealed by echocardiography. INTERVENTIONS: He was transferred to intensive care unit, where invasive ventilation was used for him during the whole hospitalization. Prone position ventilation, vasoconstrictor, antibacteria, and antiviral therapy were given. OUTCOMES: He died on the twelfth day after admission. CONCLUSIONS: Subcutaneous emphysema and pneumothorax may occur in patients with SARS-CoV-2 pneumonia and chronic pulmonary disease. Chronic cardiac disease might be aggravated by SARS-CoV-2 infection, and develop heart failure.


Subject(s)
Coronavirus Infections/complications , Mediastinal Emphysema/etiology , Pneumothorax/etiology , Subcutaneous Emphysema/etiology , Aged , Betacoronavirus , Coronavirus Infections/physiopathology , Humans , Male , SARS-CoV-2
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