CLINICAL CHARACTERISTICS AND OUTCOME OF PNEUMOMEDIASTINUM AND PNEUMOTHORAX IN PATIENTS WITH COVID-19 PNEUMONIA

Rana, Vishal; William, Michael; Kewalramani, Anjali; Azaz Cheema, Muhammad; Greg, Haggerty; Iftikhar, Asma

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Pneumomediastinum (PM) and Pneumothorax (PTX) is an uncommon potentially life-threatening accumulation of air within the mediastinum and lungs that is traditionally associated with barotrauma, injury to the esophagus, trachea, lung, or pleural space.The association between PM and PTX with coronavirus 2019 (COVID-19) has not been well studied yet. We sought to summarize the limited body of literature regarding PM and PTX in patients with COVID-19 and characterize the presentation and clinical outcomes in patients with severe acute respiratory syndrome (SARS)-COV-2 pneumonia at our institution to better define the incidence, prognosis, and available treatment for this condition. METHODS: The study is a retrospective analysis of radiology records and chart review that was conducted for a total of 1394 patients identified with Covid pneumonia from which 1.4% patients, admitted from March 1st 2020 to March 1st 2021, were found with pneumomediastinum and/or pneumothorax. Clinical characteristics and outcomes were collected and descriptive statistics were analyzed. RESULTS: Twenty patients met inclusion criteria. The majority of the patients were males (75%) and the remaining females (25%). The mean age was 66.1 ± 13.05 for males and 67 ± 13.95 for females. Over the course of the hospitalization, 55% were intubated, 25% remained on nasal cannula, 15% were on a combination of bilevel positive airway pressure and high flow nasal cannula and 5% did not require any supplement oxygenation. The incidence of PM and PTX develops approximately at a mean of 12.6 ± 9.72 day of admission. Improvement was seen in 60% of the patients, whereas death was seen in 40%. The clinical outcome of the 60% with improvement is unknown after discharge. CONCLUSIONS: Pneumomediastinum and pneumothorax, although rare phenomenon's, were more prevalent in COVID-19 patients compared with historical patients with adult respiratory distress syndrome.The etiology of this condition may be attributed to higher susceptibility of patients infected with SARS-CoV-2 to a combination of barotrauma and airway injury. In patients with confirmed or suspected COVID-19, the development of acute or worsening dyspnea with rapid deterioration of clinical status is suspicious for the presence of pneumomediastinum or pneumothorax. CLINICAL IMPLICATIONS: Pneumomediastinum and pneumothorax in COVID-19 patients should be monitored for closely and considered in patients with acute worsening or decompensation, if the patient is on non-invasive or mechanical ventilation. DISCLOSURES: No relevant relationships by Muhammad Azaz Cheema, source=Web Response No relevant relationships by Haggerty Greg, source=Admin input No relevant relationships by Asma Iftikhar, source=Web Response No relevant relationships by Anjali Kewalramani, source=Web Response No relevant relationships by Vishal Rana, source=Web Response No relevant relationships by Michael William, source=Web Response