Spontaneous pneumomediastinum with extensive subcutaneous emphysema complicating a COVID-19 pneumonia
Presentation
Known case of COVID-19 pneumonia, admitted for worsening of the clinical symptoms.
Patient Data
Bilateral multifocal ground-glass opacities are seen in both lungs mainly of peripheral distribution with areas of consolidation and inter-lobular septal thickening. Few pulmonary bullae are noted in the right upper and lower lobes.
Extensive pneumomediastinum surrounding the trachea and vascular mediastinal structures, extending to the soft tissues of the cervicofacial region, chest wall, axillary and scapular regions. Rim of gas around the lung apices indicating small pneumothoraces
No pleural effusion/mediastinal or hilar lymphadenopathy was seen on the mediastinal window (not shown).
Case Discussion
Spontaneous pneumomediastinum with subcutaneous emphysema is considered as rare life-threatening complications of COVID-19 pneumonia 1.
The mechanisms may include 1:
- anatomical abnormalities: pulmonary emphysematous bullae
- intense and persistent physical stress: violent cough which may increase the intrathoracic pressure with alveolar rupture
- genetic predisposing factors: history of spontaneous pneumothorax
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