Spontaneous Pneumomediastinum and Pneumothorax in Nonintubated COVID-19 Patients: A Multicenter Case Series

Iuorio, Angela; Nagar, Francesca; Attianese, Laura; Grasso, Anna; Torretta, Giacomo; Fusco, Pierluigi; Ferrara, Maurizio; Ferraro, Fausto

Case series Patients: Male, 78-year-old • Male, 70-year-old • Male, 73-year-old Final Diagnosis: Pneumomediastinum • pneumothorax Symptoms: Cough Medication: — Clinical Procedure: — Specialty: Anesthesiology OBJECTIVE: Rare coexistence of disease or pathology BACKGROUND: COVID-19 caused by SARS-CoV-2 has become a global pandemic. Diagnosis is based on clinical features, nasopharyngeal swab analyzed with real-time reverse transcription-polymerase chain reaction, and computer tomography (CT) scan pathognomonic signs. The most common symptoms associated with COVID-19 include fever, coughing, and dyspnea. The main complications are acute respiratory distress syndrome, pneumonia, kidney failure, bacterial superinfections, coagulation abnormalities with thromboembolic events, sepsis, and even death. The common CT manifestations of COVID-19 are ground-glass opacities with reticular opacities and consolidations. Bilateral lung involvement can be present, especially in the posterior parts and peripheral areas. Pleural effusion, pericardial effusion, and lymphadenopathy are rarely described. Spontaneous pneumothorax and pneumomediastinum have been observed as complications in patients with SARS-CoV-2 pneumonia during mechanical ventilation or noninvasive positive pressure ventilation, as well as in patients with spontaneous breathing receiving only oxygen therapy via nasal cannula or masks. CASE REPORTS: We present 2 cases of pneumomediastinum with and without pneumothorax in patients with active SARS-Cov-2 infection and 1 case of spontaneous pneumothorax in a patient with a history of paucisymptomatic SARS-CoV-2 infection. In these 3 male patients, ages 78, 73, and 70 years, respectively, COVID-19 was diagnosed through nasopharyngeal sampling tests and the presence of acute respiratory distress syndrome. CONCLUSIONS: Both pneumothorax and pneumomediastinum, although rare, may be complications during or after SARS-CoV-2 infection even in patients who are spontaneously breathing. The aim of this study was to describe an increasingly frequent event whose early recognition can modify the prognosis of patients.