SPONTANEOUS PNEUMOMEDIASTINUM: PROGNOSTIC MARKER IN PATIENTS WITH COVID-19 PNEUMONIA?
Chest
; 162(4):A2478, 2022.
Article
in English
| EMBASE | ID: covidwho-2060950
ABSTRACT
SESSION TITLE COVID-19 Case Report Posters 2 SESSION TYPE Case Report Posters PRESENTED ON 10/19/2022 1245 pm - 0145 pm INTRODUCTION:
Pneumomediastinum is the presence of air or other gas in the mediastinum which can be due to trauma related to mechanical ventilation or spontaneous in preexisting lung diseases. Here, we present the case of Covid-19 pneumonia, who developed pneumomediastinum without any trauma or other risk factors. CASE PRESENTATION A 56-year-old male COVID unvaccinated with a history of essential hypertension presented to the ED with shortness of breath and worsening cough for one week. He was living with his father, who was admitted to the ICU and receiving treatment for COVID pneumonia. The patient appeared to be in respiratory distress. His initial vital signs were temperature of 99.6 F, respiratory rate of 26 breaths per minute, blood pressure 125/71 mm Hg, heart rate 109 beats per minute with a regular rhythm, and oxygen saturation of 50% while he was breathing ambient air. Pulmonary examination revealed use of respiratory accessory muscle and widespread bilateral coarse rhonchi on auscultation. The rest of the physical examination was within normal limits. RT- PCR COVID -19 test was positive. The blood gas analysis reported respiratory alkalosis. Inflammatory markers were elevated erythrocyte sedimentation rate (35.2 mg/L), C-Reactive Protein (17.70 mg/dL), Ferritin (1108.1 ng/mL), Lactate Dehydrogenase (813 U/L), Lactate (2.4 mg/dL), D-Dimer (35.20 mg/L) and Troponin High Sensitivity-236.6 ng/L. His CBC, electrolytes, and kidney function were normal. Chest X-ray showed Pneumomediastinum with dense basilar predominant consolidation. CT Angio Chest with contrast reported Pneumomediastinum likely from the left central airway source and bilateral dense ground glass consolidation. An echocardiogram showed an ejection fraction of 60-65%, no valvular abnormalities. He was placed on vapotherm(Oxygen 40L/min) with 100% FiO2. He was given Dexamethasone 6mg for ten days, Remdesivir, Barcitinib, and a 7-day course of Azithromycin and Ceftriaxone for community-acquired pneumonia. He was advised to practice prone positioning for 12 hours or more per day. Pulmonology, Infectious Disease, and Cardiology were consulted. Gradually, his oxygen requirement was weaned down and Pneumomediastinum resolved on serial chest x rays. He was discharged on home oxygen in a clinically stable condition.DISCUSSION:
Pneumomediastinum in viral pneumonia is rare. The exact mechanism is unknown. Covid-19 pneumonia causes diffuse alveolar wall damage, which might cause air leakage into the mediastinum. The development of pneumomediastinum is an ominous sign in these patients. Fortunately, our patient did not worsen and was weaned off high flow oxygenation requirement.CONCLUSIONS:
Few isolated reported cases of pneumomediastinum in a COVID-19 patient have been associated with life-threatening complications. It should be used as a prognostic marker, and close monitoring of these patients is advisable. Reference #1 Damous, S.H.B., dos Santos Junior, J.P., Pezzano, Á.V.A. et al. Pneumomediastinum complicating COVID-19 a case series. Eur J Med Res 26, 114 (2021) DISCLOSURES No relevant relationships by Saad Ansari No relevant relationships by Akshit Chitkara No relevant relationships by Sudeshna Ghosh No relevant relationships by Femina Patel
azithromycin; C reactive protein; ceftriaxone; D dimer; dexamethasone; electrolyte; endogenous compound; ferritin; glass; lactate dehydrogenase; lactic acid; oxygen; remdesivir; troponin; adult; airway; ambient air; antibiotic sensitivity; artificial ventilation; auscultation; blood gas analysis; blood pressure; breathing; breathing rate; cardiology; case report; case study; clinical article; communicable disease; community acquired pneumonia; complication; conference abstract; coronavirus disease 2019; coughing; COVID-19 testing; drug combination; dyspnea; echocardiography; erythrocyte sedimentation rate; essential hypertension; father; ferritin blood level; fraction of inspired oxygen; heart ejection fraction; heart rate; human; kidney function; lung alveolus wall; lung disease; male; mediastinum; middle aged; oxygen saturation; oxygenation; physical examination; pneumomediastinum; pneumonia; pulmonology; respiratory alkalosis; respiratory distress; rhonchus; risk factor; thorax radiography; virus pneumonia; vital sign
Full text:
Available
Collection:
Databases of international organizations
Database:
EMBASE
Type of study:
Prognostic study
Language:
English
Journal:
Chest
Year:
2022
Document Type:
Article
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