Abstract
OBJECTIVES:To evaluate the presentation characteristics and disease course of seven patients with COVID-19 who spontaneously developed pneumomediastinum without a history of mechanical ventilation.METHODS:A total of seven non-intubated patients with COVID-19, of age ranging from 18-67 years, who developed spontaneous pneumomediastinum between 01 April and 01 October 2020 were included in the study. Patients' demographic data, clinical variables, and laboratory values were examined. Spontaneous pneumomediastinum was evaluated using posteroanterior chest radiography and thorax computed tomography.RESULTS:During the research period, 38,492 patients reported to the emergency department of our hospital with COVID-19 symptoms. Of these, spontaneous pneumomediastinum was detected in seven patients who had no previous history of intubation. Chronic obstructive pulmonary disease (2/7) and asthma bronchiale (2/7) were determined as the most common causes of comorbidity.CONCLUSIONS:In our study, the frequency of spontaneous pneumomediastinum developing without pneumothorax was found to be high in non-intubated patients. Whether this is related to the nature of the disease or it is a result of the increase in cases diagnosed incidentally owing to the increasing use of low-dose computed tomography should be explored in further studies.
Highlights
Pneumomediastinum (PM) is the collection of free air within the mediastinum
Our study aims to evaluate the presentation characteristics and course of the disease in seven patients with spontaneous pneumomediastinum (SPM) who were diagnosed with COVID-19 without endotracheal intubation in the hospital or before and did not develop pneumothorax during the course of treatment
38,492 patients reported to the emergency department of our hospital with COVID-19 symptoms
Summary
Pneumomediastinum (PM) is the collection of free air within the mediastinum. It was first described by Hamman in 1939. PM was defined as the entry of free air from the peribronchovascular tissue to the mediastinum (Macklin effect) as a result of tears in the terminal alveoli of the lung due to increased intraalveolar pressure [1,2]. Spontaneous pneumomediastinum (SPM) is rare, it mostly occurs as a result of the rupture of pulmonary alveoli in healthy young men. Predisposing factors for spontaneous alveolar rupture include asthma, chronic obstructive lung disease (COPD), interstitial lung diseases, tobacco use, continuous use of legal or illegal inhaler drugs, vomiting, cough, upper respiratory tract infections, constipation, physical exercise, respiratory distress syndrome and rarely, events or conditions such as balloon blowing, playing wind instruments, or convulsions [3,4,5]. While SPM is observed as a complication of mechanical ventilation in patients with viral pneumonia, the development of this condition in nonintubated patients suggests an alternative etiology [9]
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