Pneumomediastinum Associated With Severe Cough Following SARS-CoV2 Infection

Abstract

Introduction: Pneumomediastinum (PM) is a low-frequency reason for consultation in pediatric services and is defined as the presence of free air in mediastinum structures as a result of overexpansion and rupture of alveolar septa, allowing air to pass through tissue barriers and occupy the mediastinum, neck and other cavities. Incidence of PM in newborns is 1,7-2,5 for every 1000, and in older children it is 1 for every 8000 to 15000 children. PM is more frequent in males and can be subdivided in two categories: spontaneous and secondary. Summary Case: We present the case of an 11-year-old boy without personal history of other pathologies, with history of a recent low-severity infection by Sars-CoV2 that lasted 4 weeks. He consulted pediatric emergency room for two days of odynophagia, acute cough episodes, thoracic pain and bilateral crackling sounds and tumefaction in the subclavicular and neck regions. He was without signs of dyspnea, and thoracic pain 7/10, SatO2 94% in room air, tumefaction was identified bilaterally in subclavicular and neck regions that expanded to the anterior side of the thorax. Crackling sounds were discovered in palpation of these regions, as well as diffuse pain. Respiratory sounds was normal. CXR showed air in the subcutaneous cellular tissue in the neck and thorax. Supplementary oxygen was administered via nasal cannula, as well as analgesic medication. Following studies were ordered to investigate possible causes: chest CT showed PM. The patient's clinical course was favorable and was discharged with no further complications.Discussion: PM is a low-frequency entity in pediatric health care. Several risk factors have been described such as asthma, respiratory infections, inhaled irritating substances and anatomical alterations such as tracheomalacia. Rarely it has been reported in patients affected by COVID-19 and such finding could represent a radiological indicator of potential progression of disease. While it is usually a self-limited condition and resolves by itself during clinical observation, PM can provoke potentially fatal respiratory or cardiovascular events. PM can be identified in simple thorax radiography, however, if it is small it can only be detected through chest CT. Literature reports cases in which PM in COVID-19 patients was not related to mechanical ventilation. This case highlights the association of COVID-19 with PM and the need for health care teams to be alert of this complication, even in patients with no previous history of any other pathological entities or comorbidities.