Spontaneous pneumomediastinum and spontaneous pneumothorax in patients with COVID-19

Abstract

Background. Spontaneous pneumomediastinum is a rare complication of bronchopulmonary diseases, due to the pandemic of a new coronavirus infection, there has been an increase in the number of patients with this pathology, as well as with spontaneous pneumothorax. In the latest version of the recommendations for the treatment of COVID- 19, there is no information on these complications. The purpose of the work is to study the features of spontaneous pneumomediastinum and spontaneous pneumothorax in patients with viral pneumonia caused by SARS-CoV-2. Materials and methods. The results of examination and treatment of 24 patients with a complicated course of COVID-19 viral pneumonia are presented, of which pneumomediastinum was observed in 10, spontaneous pneumothorax – in 12, and both complications – in 2 patients. The virus was identified in 16 patients, and the rest were clinically diagnosed with COVID-19 viral pneumonia. Pneumomediastinum and pneumothorax were confirmed by ultrasound radiological methods. Results and conclusions. Spontaneous pneumomediastinum at the onset was detected mainly with the help of multispiral computed tomography, did not lead to a significant deterioration in the condition of patients and in most cases was eliminated by conservative methods. Spontaneous pneumothorax at the onset was established using physical methods, its effect on the course of the disease and outcomes depended on the degree of compression of the lung and the persistence of bronchopleural communication. Pneumothorax was resolved by drainage of the pleural cavity with intermittent vacuum aspiration. The causes of fatal outcomes were an increase in the activity of the inflammatory process and the progression of the volume of the affected lung tissue in elderly patients with the presence of background and concomitant diseases. Pneumomediastinum and pneumothorax in this group of patients occurred against the background of invasive ventilation and contributed to the development of a fatal outcome.

Keywords

• covid-19 viral pneumonia
• spontaneous pneumomediastinum
• spontaneous pneumothorax