ACUTE TRACHEAL TEAR: A POTENTIAL CAUSE OF SPONTANEOUS PNEUMOMEDIASTINUM IN PATIENTS WITH COVID-19

Abstract

TYPE: Abstract TOPIC: Critical Care PURPOSE: Spontaneous pneumomediastinum (SP) is defined as free air in the mediastinum without a precipitating cause and has recently been described as an additional potential complication of coronavirus disease 2019 (COVID-19). It may carry a poor prognosis. We aim to identify a potential cause for patients with COVID-19 who present with spontaneous pneumomediastinum prior to initiation of mechanical ventilation. METHODS: Three male patients, age 66, 61, and 70, average body mass index 28kg/m2, with severe COVID-19 pneumonia were admitted to intensive care with SP prior to initiation of mechanical ventilation had bronchoscopic and radiological evidence of acute tracheal tear. None developed associated pneumothoraces. Upon further deterioration each patient was commenced on mechanical ventilatory support. RESULTS: Acute tracheal tear was confirmed in all patients in the lower membranous trachea, with one patient having two diametrically opposite tracheal tears. Following multidisciplinary team discussions, all were managed conservatively. Unfortunately, each patient died of multi-organ failure. CONCLUSIONS: Our findings suggest that the development of pneumomediastinum and subcutaneous emphysema, following prolonged periods of severe coughing, should raise the suspicion of tracheal rupture in COVID-19 patients. CLINICAL IMPLICATIONS: We recommend that all COVID-19 positive patients, who show signs of SP, should undergo urgent bronchoscopy to exclude a tracheal tear. Early diagnosis is essential to permit multidisciplinary team discussions to define therapeutic strategies. DISCLOSURE: Nothing to declare. KEYWORD: COVID-19