Simultaneous Occurrence of Pneumomediastinum, Pneumopericardium and Surgical Emphysema in a Patient of COVID-19: WA Case Report
Abstract
As we enter the third year of the COVID pandemic, the SARS-CoV-2 virus keeps on surprising clinicians globally with atypical manifestations. Spontaneous pneumomediastinum is the accumulation of free air within the mediastinum without any preceding trauma or invasive procedure. Pneumomediastinum has been recently reported in the literature, often with associated mortality and morbidity in COVID-19 patients exposed to positive pressure ventilation due to barotrauma. We report the case of a 47-year-old man admitted for management of infection by the SARS-CoV-2. After one week of in-patient treatment, the patient still had worsening dyspnea. Repeat chest X-ray revealed surgical emphysema in neck and pneumomediastinum and pneumopericardium NCCT chest revealed. The spontaneous pneumomediastinum and pneumopericardium with surgical emphysema resorbed over 22 days with a favourable clinical outcome without any invasive intervention. Patient was discharged subsequently with vitals maintaining on room air. A keen clinical observation and timely imaging study can help in detecting these complications early and direct the management accordingly.
How to cite this article:
Sharma G, Chhabra K, Kummetha LC, Sharma S, Pradhan GS, Kumar N. Simultaneous Occurrence of Pneumomediastinum, Pneumopericardium and Surgical Emphysema in a Patient of COVID-19:
A Case Report. J Adv Res Med. 2021;8(4):17-22.
DOI: https://doi.org/10.24321/2349.7181.202118
References
Ghani M, Rodriguez-Ortiz Y, Ahmad D, Pham J, Tamsukhin P, Mir P. Spontaneous pneumomediastinum
in patients with SARS-CoV-2 Virus (COVID-19). CHEST. 2020 Oct 1;158(4):A1231-2. [PubMed] [Google Scholar]
Zu ZY, Jiang MD, Xu PP, Chen W, Ni QQ, Lu GM. Coronavirus Disease 2019 (COVID-19): A Perspective
from China. Radiology. 2020 Aug 29;6(2):15-25. [PubMed] [Google Scholar]
Mousa S, Edriss H. Pneumomediastinum secondary to invasive and non-invasive mechanical ventilation. SW
Res Crit Care Chron. 2019 Jan 18;7(27):36-42. [Google Scholar]
Kouritas VK, Papagiannopoulos K, Lazaridis G, Baka S, Mpoukovinas I, Karavasilis V. Pneumomediastinum. J
Thorac Dis. 2015 Feb;7(1):S44-9. [PubMed] [Google Scholar]
Oxford Academic [Internet]. Spontaneous pneumomediastinum: 41 cases. Eur J Cardiothorac Surg . 2007
Jun;31(6):1110-4. [PubMed]
McGuinness G, Zhan C, Rosenberg N, Azour L, Wickstrom M, Mason DM. Increased Incidence of Barotrauma
in Patients with COVID-19 on Invasive Mechanical Ventilation. Radiology. 2020 Nov;297(2):252-62.
[PubMed] [Google Scholar]
Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C. Pathological findings of COVID-19 associated with
acute respiratory distress syndrome. Lancet Respir Med. 2020 Apr;8(4):420-2. [PubMed] [Google Scholar]
APSR [Internet]. ATS/APSR webinar on COVID-19 [cited 2021 Dec 10]. Available from: https://www.apsresp.
org/archive/covid-19/webinar-20200327.html.
Gibson PG, Qin L, Puah SH, COVID-19 acute respiratory distress syndrome (ARDS): clinical features and
differences from typical pre-COVID-19 ARDS. Med J Aust. 2020 Jul;13(2):54-56. [PubMed] [Google Scholar]
Li X, Ma X. Acute respiratory failure in COVID-19: is it “typical†ARDS? Crit Care . 2020 May 6;24(1):198.
[PubMed] [Google Scholar]
Macklin MT, Macklin CC. Malignant interstitial emphysema of the lungs and mediastinum as an
important occult complication in many respiratory diseases and other conditions: An interpretation of the
clinical literature in the light of laboratory experiment. Medicine. 1944 Dec;23(4):281-358. [Google Scholar]
Scacciavillani R, Iannaccone G, Del Buono MG, Bello G. Pneumopericardium following mechanical ventilation
in COVID-19 pneumonia. Eur Heart J Case Rep. 2020 Oct;4(FI1):1-2. [PubMed] [Google Scholar]
Sahu KK, Mishra AK, Goldman Y. A rare case of Pneumopericardium secondary to COVID-19. Heart
Lung J Crit Care. 2020 Nov 1;49(6):679-80. [PubMed] [Google Scholar]
Juárez-Lloclla JP, León-Jiménez F, Urquiaga-Calderón J, Temoche-Nizama H, Bryce-Alberti M, Portmann-
Baracco A, et al. Spontaneous Pneumopericardium and Pneumomediastinum in Twelve COVID-19 Patients.
Arch Bronconeumol. 2021 Jan 1;57:86-8. [PubMed] [Google Scholar]
Lee YJ, Jin SW, Jang SH, Jang YS, Lee EK, Kim YJ, Lee MY, Park JC, Rho TH, Kim JH, Hong SJ. A case of spontaneouspneumomediastinum and pneumopericardium in a young adult. Korean J Intern Med. 2001 Sep 1;16(3):205-9. [Google Scholar]
Hazariwala V, Hadid H, Kirsch D, Big C. Spontaneous pneumomediastinum, pneumopericardium, pneumothorax and subcutaneous emphysema in patients with COVID-19 pneumonia, a case report. J Cardiothorac Surg. 2020 Oct 7;15:301. [PubMed] [Google Scholar]
Cut TG, Tudoran C, Lazureanu VE, Marinescu AR, Dumache R, Tudoran M. Spontaneous Pneumomediastinum,
Pneumothorax, Pneumopericardium and Subcutaneous Emphysema-Not So Uncommon Complications
in Patients with COVID-19 Pulmonary Infection-A Series of Cases. J Clin Med. 2021 Mar 24;10(7):1346.
[PubMed] [Google Scholar]
Rashedi S, Mardani M, Fooladgar M, Aliannejad R. Spontaneous pneumomediastinum, pneumopericardium,
pneumothorax, and subcutaneous emphysema in a patient with COVID-19. Radiol Case Rep. 2021
May;16(5):1158-61. [PubMed] [Google Scholar]
Goldman N, Ketheeswaran B, Wilson H. COVID-19-associated pneumomediastinum. Clin Med. 2020 Jul
;20(4):e91-2. [PubMed] [Google Scholar]
Wang W, Gao R, Zheng Y, Jiang L. COVID-19 with spontaneous pneumothorax, pneumomediastinum and
subcutaneous emphysema. Journal of Travel Medicine. 2020 Aug 20;27(5):62. [PubMed] [Google Scholar]
Quincho-Lopez A, Quincho-Lopez DL, Hurtado-Medina FD. Case Report: Pneumothorax and
Pneumomediastinum as Uncommon Complications of COVID-19 Pneumonia-Literature Review. Am J Tr
Med Hyg. 2020 Jul 23;103(3):1170-6. [PubMed] [Google Scholar]
Singh A, Bass J, Lindner DH. Rare Complication of Pneumomediastinum and Pneumopericardium in a
Patient with COVID-19 Pneumonia. Case Reports in Pulmonology. 2020 Nov 2;2020:e8845256. [PubMed]
[Google Scholar]
Khan HH, Witkowski A, Clark JA, Mata A. A 17-Year-Old Girl with a Recent History of Marijuana Use Presented
with Pneumomediastinum and Pneumopericardium and Tested Positive for SARS-CoV-2 Infection on Hospital
Admission. Am J Case Rep. 2021 Jun 16;22:e931800. [Google Scholar]
Pimenta I, Varudo R, Lança S, Gonzalez FA. Exuberant spontaneous pneumothorax, pneumomediastinum,
pneumopericardium and subcutaneous emphysema in COVID-19 pneumonia. BMJ Case Reports CP. 2021
May 1;14(5):e243861. [Google Scholar]
Copyright (c) 2021 Gaurav Sharma, Karan Chhabra, Lalit Chandra Kummetha, Shivani Sharma, Gaurav S Pradhan, Naresh Kumar
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
