Spontaneous pneumomediastinum, pneumothorax and subcutaneous emphysema in COVID-19: case report and literature review

Shan, Shi; Guangming, Li; Wei, Lei; Xuedong, Yang

doi:10.1590/S1678-9946202062076

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CASE REPORT • Rev. Inst. Med. trop. S. Paulo 62 • 2020 • https://doi.org/10.1590/S1678-9946202062076 copy

Spontaneous pneumomediastinum, pneumothorax and subcutaneous emphysema in COVID-19: case report and literature review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Coronavirus Disease 2019 (COVID-19) has rapidly spread worldwide. Numerous studies have shown its typical and atypical CT findings. We report one COVID-19 patient who presented with a transient pneumothorax, spontaneous pneumomediastinum (SP), as well as subcutaneous emphysema during hospitalization. Chest CT andclinical findings were discussed, and a literature review is presented. The probable cause of SP in COVID-19 was alveolar damage. Once pneumothorax and SP were present, the patient should be carefully monitored to prevent respiratory deterioration, especially when lung lesions are severe.

Spontaneous pneumomediastinum; Pneumothorax; Alveolar damage

Test	Value (local reference range) February 7^th	Value on February 14^th
SpO2	93% (95-99%)	96%
blood oxygen saturation	88% (98%)	-
lymphocyte ratio	7.1% (20-40%)	8.9%
lymphocyte count	0.58×10^9/L (1.1-3.2×10^9)	1.10×10^9/L
neutrophil ratio	89.5% (40-75%)	86.1%
neutrophil count	7.30×10^9/L (1.8-6.3×10^9/L)	10.69×10^9/L
C-reactive protein	110.00 mg/L (0.8-8 mg/L)	-
Erythrocyte sedimentation rate	40 mm/h (0-15 mm/h)	-
LDH	384 U/L (110-240 U/L)	257 U/L
ALT	106 U/L (30 U/L)	26 U/L
AST	28 U/L (29-35 U/L)	25 U/L

Authors	Age/Sex	Image alterations	Lung lesion	Respiratory support	Clinical outcome
Kolani et al.⁴	23/F	Small amount of spontaneous pneumomediastinum, no emphysema or pneumothorax	Inconspicuous ground glass opacity in the lower left inferior lobe	No	Recovered
Zhou et al.⁵	38/M	Spontaneous pneumomediastinum and subcutaneous emphysema	Multiple ground-glass opacities with bilateral parenchymal consolidation and interlobular septal thickening	Supplemental oxygen	Recovered
Wang et al.⁶	62/M	Spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema	Multiple ground-glass opacities with parenchymal consolidation, pneumothorax on the right	High-flow nasal cannula	Recovered
Mohan and Tauseen⁷	49/M	Severe pneumomediastinum with extensive subcutaneous emphysema mainly extending superiorly in the thorax and to the neck without evidence of pneumothorax	Bilateral patchy infiltrates mainly distributed in the middle and lower lung lobes.	Non-invasive supplemental oxygen	Recovered
Wang et al.⁸	36/F	Spontaneous pneumomediastinum	Multiple diffuse patchy consolidation areas and ground-glass opacities in both lungs，the total lung severity score of the patient was 19 out of 20	Noninvasive ventilation	Died
Ucpinar et al.⁹	82/F	Spontaneous pneumomediastinum, left sided massive pneumothorax, subcutaneous emphysema in the neck posterior thoracic wall	Widespread bilateral GGO, predominantly in lower lobes	No	Recovered
Flower et al.¹⁰	36/M	Left- sided tension pneumothorax	Widespread areas of patchy consolidation	No	Recovered
Rohailla et al.¹¹	26/M	Large right pneumothorax with complete collapse of the right lung	No defined intrapulmonary inflammation was found on chest radiograph	No	Recovered

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E-mail: revimtsp@usp.br

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[1] Correspondence to: Yang Xuedong China Academy of Traditional Chinese Medical Sciences, Guang’anmen Hospital, Department of Radiology, Beixian’ge Road 5, Xicheng District, 100053, Beijing, China Tel: +86 13811059499 E-mail:yangxuedong1@163.com