ABSTRACT
The presenting symptoms and features of COVID-19 are non-specific and may be extrapulmonary complications such as thrombotic disorders but also pneumothorax, pneumomediastinum and subcutaneous emphysema; which are well-known complications of mechanical ventilation. Nevertheless, pneumothorax and/or pneumomediastinum, could complicate the course of a COVID-19 disease even in the absence of barotrauma involved. Herein, we report the case of a 55-year-old man with a previous history of erythroblastopenia due to thymoma admitted for COVID-19-related acute respiratory distress syndrome (ARDS) who simultaneously developed spontaneous tension pneumothorax, pneumomediastinum, subcutaneous emphysema and acute bilateral pulmonary embolism as presenting features of COVID-19 while on high-flow nasal cannula. This rare case highlights the importance of screening for other coexisting alternative diagnoses at the initial presentation of a patient suspected of COVID-19.
Subject(s)
COVID-19/diagnosis , Respiratory Distress Syndrome/virology , Acute Disease , COVID-19/complications , Hospitalization , Humans , Male , Mediastinal Emphysema/virology , Middle Aged , Pneumothorax/virology , Pulmonary Embolism/virology , Subcutaneous Emphysema/virologyABSTRACT
The development of spontaneous pneumomediastinum and subcutaneous emphysema are few of the rare clinical manifestations observed in coronavirus disease-19 (COVID-19) patients which are yet to be fully understood. Most cases of spontaneous pneumomediastinum arise due to factors causing high intra-alveolar pressure. Herein, we report a case of a COVID-19 positive elderly male, who presented with spontaneous pneumomediastinum and subcutaneous emphysema unrelated to high-pressure ventilatory measures, detected on chest computed tomography (CT). Despite acute medical care, the patient progressed towards a more serious clinical course. Male gender and diffuse alveolar damage caused by COVID-19 seems to be the most relevant association in this case. However, we have enlightened other possible pathological mechanisms and their association with severity index of COVID-19.
Subject(s)
COVID-19/complications , Mediastinal Emphysema/diagnostic imaging , Subcutaneous Emphysema/diagnostic imaging , COVID-19/physiopathology , Disease Progression , Humans , Male , Mediastinal Emphysema/virology , Middle Aged , Subcutaneous Emphysema/virology , Tomography, X-Ray ComputedABSTRACT
Real-Time-reverse-transcription-Polymerase-Chain-Reaction from nasopharyngeal swabs and chest computed tomography (CT) depicting typically bilateral ground-glass opacities with a peripheral and/or posterior distribution are mandatory in the diagnosis of COVID-19. COVID-19 pneumonia may present though with atypical features such as pleural and pericardial effusions, lymphadenopathy, cavitations, and CT halo sign. In these two case-reports, COVID-19 presented as pneumothorax, pneumomediastinum and subcutaneous emphysema in critically ill patients. These disorders may require treatment or can be even self-limiting. Clinicians should be aware of their potential effects on the cardiorespiratory status of critically ill COVID-19 patients. Finally, pneumothorax can be promptly diagnosed by means of lung ultrasound. Although operator dependent, lung ultrasound is a useful bedside diagnostic tool that could alleviate the risk of cross-infection related to COVID-19 patient transport.
Subject(s)
COVID-19/complications , Mediastinal Emphysema , Pneumothorax , Subcutaneous Emphysema , Humans , Intensive Care Units , Male , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/virology , Middle Aged , Pneumothorax/diagnostic imaging , Pneumothorax/virology , Subcutaneous Emphysema/diagnostic imaging , Subcutaneous Emphysema/virologyABSTRACT
Spontaneous pneumomediastinum (SPM) and pneumothorax (PNX) unrelated to positive pressure ventilation has been recently reported as an unusual complication in cases of severe COVID-19 pneumonia. The presumed pathophysiological mechanism is diffuse alveolar injury leading to alveolar rupture and air leak. We present a case of COVID-19 pneumonia complicated on day 13 post admission by SPM, PNX and subcutaneous emphysema in a patient with no identifiable risk factors for such complication. The patient received medical treatment for his COVID-19 infection without the use of an invasive or non-invasive ventilator. Moreover, he is a non-smoker with no lung comorbidities and never reported a cough. He was eventually discharged home in stable condition. A comprehensive literature review revealed 15 cases of SPM developing in patients with COVID-19 pneumonia.
Subject(s)
COVID-19/complications , Mediastinal Emphysema/virology , Pneumothorax/virology , Subcutaneous Emphysema/virology , COVID-19/diagnostic imaging , Humans , Male , Middle Aged , SARS-CoV-2ABSTRACT
Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome virus coronavirus 2 (SARS-CoV-2). As known, COVID-19 has become a global pandemic and serious health problem. Disease mainly affects lungs and common findings are fever cough and shortness of breath. Computerized tomography (CT) has an important role in initial evaluation and follow up of COVID-19. Main (CT) finding of the disease is bilateral extensive ground-glass opacification (GGO) with a peripheral or posterior distribution, mainly involving the lower lobes. In this case report, we present a pneumothorax and subcutaneous emphysema case in a patient with COVID-19. To the best of authors' knowledge, it is the first illustrated case of pneumothorax accompanying COVID-19 pneumonia.
Subject(s)
Coronavirus Infections/complications , Pneumonia, Viral/complications , Pneumothorax/virology , Subcutaneous Emphysema/virology , Aged, 80 and over , Antiviral Agents/therapeutic use , Betacoronavirus , COVID-19 , Coronavirus Infections/diagnosis , Female , Fever/virology , Humans , Lung/diagnostic imaging , Lung/virology , Pandemics , Pneumonia, Viral/diagnosis , Pneumothorax/diagnostic imaging , SARS-CoV-2 , Subcutaneous Emphysema/diagnostic imaging , Subcutaneous Emphysema/drug therapy , Tomography, X-Ray Computed , Treatment OutcomeSubject(s)
Betacoronavirus , Coronavirus Infections/complications , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/virology , Pneumonia, Viral/complications , Subcutaneous Emphysema/diagnostic imaging , Subcutaneous Emphysema/virology , COVID-19 , Emergency Service, Hospital , Humans , Lung/diagnostic imaging , Male , Middle Aged , Pandemics , Radiography , SARS-CoV-2 , Tomography, X-Ray ComputedSubject(s)
Coronavirus Infections/complications , Mediastinal Emphysema/virology , Pneumonia, Viral/complications , Pneumothorax/virology , Subcutaneous Emphysema/virology , Betacoronavirus , COVID-19 , Coronavirus Infections/physiopathology , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/physiopathology , SARS-CoV-2 , Tomography, X-Ray ComputedSubject(s)
Influenza, Human/complications , Mediastinal Emphysema/complications , Subcutaneous Emphysema/complications , Antiviral Agents/therapeutic use , Humans , Influenza A Virus, H1N1 Subtype/drug effects , Influenza A Virus, H1N1 Subtype/genetics , Influenza A Virus, H1N1 Subtype/pathogenicity , Influenza, Human/diagnostic imaging , Influenza, Human/drug therapy , Influenza, Human/virology , Male , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/drug therapy , Mediastinal Emphysema/virology , Middle Aged , Oseltamivir/therapeutic use , Oxygen/therapeutic use , Subcutaneous Emphysema/diagnostic imaging , Subcutaneous Emphysema/drug therapy , Subcutaneous Emphysema/virology , Tomography, X-Ray ComputedABSTRACT
The occurrence of spontaneous pneumomediastinum in swine flu, or H1N1 influenza A infection, is a rare phenomenon and only few cases have been reported in children. We describe a case of spontaneous pneumomediastinum in adult infected with swine flu.