Tension Pneumomediastinum in a COVID-19 Patient

Abstract

A 60-year-old man with COVID-19 was mechanically ventilated for 32 days before his condition abruptly worsened with hemodynamic collapse: tachycardia (124 beats/min), hypotension (90/50 mm Hg), distended neck veins, and muffled heart sounds (Beck’s triad). Computed tomography (CT) demonstrated tension pneumomediastinum with compressed cardiac chambers simulating acute cardiac tamponade (Fig 1). The patient was transported to a negative pressure interventional suite with a CT scanner. CT-guided drainage was performed using the trocar method via the anterior fourth intercostal space and a Wayne Pneumothorax Catheter (Cook Medical, Bloomington, Indiana) advanced posterosuperiorly, preattached to a closed drainage system to prevent aerosolization, with audible gas escape into the system, followed by immediate circulatory recovery.