PNEUMOMEDIASTINUM AS A COMPLICATION OF COVID-19 PNEUMONIA: CASE SERIES

Abstract

Background: Pneumomediastinum (PM) is a rare pathological entity that is divided into two categories: secondary - with a known etiological factor, and spontaneous - with no clear etiology. This publication aims to highlight the two categories of PM as a complication of COVID-19 pneumonia. Case series: Six patients with PM as a complication of COVID-19 pneumonia were included in this study. Conventional chest X-rays and chest computed tomography were used to determine PM. In two of our patients, PM was a late consequence of COVID- 19 pneumonia. In two others, PM was established during conservative treatment of COVID-19 pneumonia. And for the last two cases, PM was diagnosed after tracheal intubation and mechanical ventilation while treating acute respiratory distress syndrome (ARDS). Concomitant spontaneous pneumothorax was found in four of our patients, leading to the invasive management of PM – drainage of the mediastinum by chest tube insertion. Conservative treatment of PM was the method of choice for the other two cases. Death was established in four cases – a rate of 75 %. Conclusion: With this case series, we highlight PM in its two forms - primary and secondary, as a serious complication of COVID-19 pneumonia. Our study highlights the importance of being aware of PM in COVID19 pneumonia, even in patients managed without mechanical ventilation.

Keywords

• mediastinum
• subcutaneous emphysema
• pneumothorax