Abstract
(1) Background: Spontaneous pneumomediastinum (PM), pneumothorax (PT), and pneumopericardium (PP) were recently reported as rare complications in patients with severe COVID-19 pneumonia, and our study aims to follow the evolution of these involvements in 11 cases. The presumed pathophysiological mechanism is air leak due to extensive diffuse alveolar damage followed by alveolar rupture. (2) Methods: We followed the occurrence of PM, PN, PP, and subcutaneous emphysema (SE) in 1648 patients hospitalized during the second outbreak of COVID-19 (October 2020–January 2021) in the main hospital of infectious diseases of our county and recorded their demographic data, laboratory investigations and clinical evolution. (3) Results: Eleven patients (0.66%) developed PM, with eight of them having associated PT, one PP, and seven SE, in the absence of mechanical ventilation. Eight patients (72.72%) died and only three (27.27%) survived. All subjects were nonsmokers, without known pulmonary pathology or risk factors for such complications. (4) Conclusions: pneumomediastinum, pneumothorax, and pneumopericardium are not so uncommon complications of SARS-CoV2 pneumonia, being observed mostly in male patients with severe forms and associated with prolonged hospitalization and poor prognosis. In some cases, with mild forms and reduced pulmonary injury, the outcome is favorable, not requiring surgical procedures, mechanical ventilation, or intensive care stay.
Highlights
Several articles, published in the medical literature worldwide [1,2,3,4], debate sporadic cases of spontaneous pneumomediastinum (PM), pneumothorax (PT), pneumopericardium (PP), and subcutaneous emphysema (SE) diagnosed in patients with SARS-CoV2 pneumonia, even in the absence of mechanical ventilation associated with barotrauma
It is known that inflammation could render the alveolar wall more prone to rupture, which could be exacerbated by a persistent cough or any factors increasing the intra-alveolar pressure
We followed the evolution of 11 patients with COVID-19, nine men and two women, aged between 36 and 78 years, mean age 58.27 ± 12.39 years, hospitalized after two to seven days, median 4.8 (2–7) days, since the onset of symptoms of SARSCoV-2 infection, the diagnosis being confirmed by a real-time polymerase chain reaction (PCR)
Summary
COVID-19 has become the largest pandemic in recent centuries and is associated with increased morbidity and mortality, as well as a large spectrum of complications. Several articles, published in the medical literature worldwide [1,2,3,4], debate sporadic cases of spontaneous pneumomediastinum (PM), pneumothorax (PT), pneumopericardium (PP), and subcutaneous emphysema (SE) diagnosed in patients with SARS-CoV2 pneumonia, even in the absence of mechanical ventilation associated with barotrauma. The principal pathophysiologic mechanism of PM is represented by the Macklin phenomenon, explaining the development of an increased pressure gradient between the marginal alveoli and the lung parenchyma, which, in the presence of the extensive alveolar injury, determines air leakage along the surrounding bronchovascular sheaths into the mediastinum. It is known that inflammation could render the alveolar wall more prone to rupture, which could be exacerbated by a persistent cough or any factors increasing the intra-alveolar pressure
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