Pneumomediastinum in patients with Covid-19 pneumonia - case series

Abstract

<b>Background and objective:</b> Spontaneous pneumomediastinum (SP) is a rare complication of COVID pneumonia; the objective of the study was to identify and characterise these patients. <b>Methods:</b> The observational retrospective study was conducted in our pulmonology department between May 2020 and February 2021, and included all consecutive patients with SP detected on chest CT, without signs of pneumothorax. We observed: time of onset, oxygen saturation in room air, level of inflammation markers and clinical outcome. <b>Results:</b> We identified 9 cases of SP among a total of 316 patients. 8 were men; mean age 57.5. At the time of identifying SP, mean CRP (Reactive Protein C) was 30 mg/l and CT scans showed extended „ground glass” opacities (&gt; 50% of the parenchyma) in all patients. The mean time of detection of the SP was 18.8 days post symptoms onset (range 13-34). 5 patients had much higher levels of CRP before the onset of the SP. Only 6 out of 9 patients had subcutaneous emphysema. 5 patients died; their mean age was 57.2 years, mean CRP 35.3 mg/l. They were in a worse state of the disease, as all of them had oxygen saturation in room air less than 75% and all were on noninvasive or mechanical ventilation at the onset of the SP. The 4 surviving patients had mean CRP 13.9 mg/dl, mean oxygen saturation 82.5% (range 80-85). Repeated CT scans showed recovery in a mean time of 18.5 days (range 8-28). <b>Conclusions:</b> SP is a rare complication of COVID 19 pneumonia: it does not occur at the highest level of inflammation and it does not produce subcutaneous emphysema in all cases. SP does not influence the prognosis of the disease as the deceased patients had a more severe state of the pneumonia at the time of the onset of the SP.