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Abid N, Nemsi E, Loukil M, Gader N, Ben Ali M, Ghrairi H. Spontaneous pneumomediastinum in patients with COVID-19 pneumonia. LA TUNISIE MEDICALE 2023; 101:313-316. [PMID: 37682278 PMCID: PMC11135184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Indexed: 09/09/2023]
Abstract
INTRODUCTION Spontaneous pneumomediastinum (SPM) is a rare affection in general population. Only few cases have been reported during this ongoing global pandemic of Coronavirus-2019 (COVID-19). The ethipathogeny of this complication is poorly understood. OBSERVATIONS we reported ten cases of SPM complicating coronavirus pneumonia. There were six me and four women. Age varies from 32 to 66 years. Pneumonia was severe for all cases defined by a bloo oxygen saturation < 90% on admission. All patients were hospitalized in intensive care unit and treated by high-flow oxygen for nine patients and non-rebreather masks for one patient. Repeated chest computed tomography (CT) scan showed resolution of the pneumomediastinum and appearance of signs of pulmonary fibrosis for four cases. CONCLUSIONS Chest CT scan must be performed in front of any sudden deterioration in respiratory status of patients with COVID-19 pneumonia to not miss mechanical complication such as SPM. This complication seems to be associated with severe forms of COVID-19.
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Affiliation(s)
- Narjes Abid
- Service de pneumologie-CHU Mohamed Taher Maamouri Nabeul / Faculté de médecine de Tunis
| | - Ella Nemsi
- Service de pneumologie-CHU Mohamed Taher Maamouri Nabeul / Faculté de médecine de Tunis
| | - Manel Loukil
- Service de pneumologie-CHU Mohamed Taher Maamouri Nabeul / Faculté de médecine de Tunis
| | - Nada Gader
- Service de pneumologie-CHU Mohamed Taher Maamouri Nabeul / Faculté de médecine de Tunis
| | - Mechaal Ben Ali
- Service de réanimation médicale-CHU Mohamed Taher Maamouri Nabeul / Faculté de médecine de Tunis
| | - Hedia Ghrairi
- Service de réanimation médicale-CHU Mohamed Taher Maamouri Nabeul / Faculté de médecine de Tunis
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El Bozouiki F, Moumkin M, El Melhaoui J, Hammi S. Intrathoracic gas effusions in patients with COVID-19. Medicine (Baltimore) 2023; 102:e32605. [PMID: 36607883 PMCID: PMC9828573 DOI: 10.1097/md.0000000000032605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Current evidence suggests that intrathoracic gas effusions (pneumomediastinum and pneumothorax) may be observed among COVID-19 patients even without mechanical ventilation. Here, we report 9 patients who developed spontaneous intrathoracic gas effusions in the absence of mechanical ventilation. The incidence of spontaneous intrathoracic gas effusions is low at 0.5% in hospitalized COVID-19 patients in the absence of respiratory support. Two patients (22.2%) had spontaneous pneumomediastinum, with or without subcutaneous emphysema. Three patients (33.3%) had pneumomediastinum associated with pneumothorax, with or without subcutaneous emphysema, and 4 patients (44.4%) had spontaneous pneumothorax. The Pneumothorax was unilateral in 66.6% of cases (6/9) but without location preference. Five of our patients were smokers, of whom 80% had isolated spontaneous pneumothorax. Other comorbidities included pulmonary tuberculosis in a single patient, diabetes in 2 patients and arterial hypertension in 1 patient. None of the patients had respiratory comorbidities. All of our patients were male. The average duration of hospital stay was 10 days (±6.63). All patients required oxygen therapy. Three patients (33.3%) with spontaneous pneumothorax required chest drainage. The evolution was favorable in 6 patients (66.7%) and worse in 3 cases (33.3%). The respiratory manifestations of COVID-19 have been stereotyped. Intrathoracic effusions may also be signs of COVID-19 with varying prognoses, or even the only presentation of the disease. This should be considered in clinical practice, and doctors are encouraged to request a SARS-CoV-2 test in this situation. Further investigations with a larger sample size are needed to identify the prognostic factors in COVID-19 patients with gas effusions.
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Affiliation(s)
- Fatima El Bozouiki
- Pneumology department, University Hospital Center of Tangier, Tetouan, AL-Hoceima
- Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Morocco
- * Correspondence: Fatima El Bozouiki, Pneumology department, University Hospital Center of Tangier, Tetouan, AL-Hoceima (e-mail: )
| | - Mohamed Moumkin
- Pneumology department, University Hospital Center of Tangier, Tetouan, AL-Hoceima
- Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Morocco
| | - Jihane El Melhaoui
- Pneumology department, University Hospital Center of Tangier, Tetouan, AL-Hoceima
- Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Morocco
| | - Sanaa Hammi
- Pneumology department, University Hospital Center of Tangier, Tetouan, AL-Hoceima
- Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Morocco
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Pescaru CC, Marc MS, Costin EO, Pescaru A, Trusculescu AA, Maritescu A, Suppini N, Oancea CI. Massive Spontaneous Pneumomediastinum-A Form of Presentation for Severe COVID-19 Pneumonia. Medicina (B Aires) 2022; 58:medicina58111525. [PMID: 36363482 PMCID: PMC9692548 DOI: 10.3390/medicina58111525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/18/2022] [Accepted: 10/24/2022] [Indexed: 01/25/2023] Open
Abstract
For COVID-19 pneumonia, many manifestations such as fever, dyspnea, dry cough, anosmia and tiredness have been described, but differences have been observed from person to person according to age, pulmonary function, damage and severity. In clinical practice, it has been found that patients with severe forms of infection with COVID-19 develop serious complications, including pneumomediastinum. Although two years have passed since the beginning of the pandemic with the SARS-CoV-2 virus and progress has been made in understanding the pathophysiological mechanisms underlying the COVID-19 infection, there are also unknown factors that contribute to the evolution of the disease and can lead to the emergence some complications. In this case report, we present a patient with COVID-19 infection who developed a massive spontaneous pneumomediastinum and subcutaneous emphysema during hospitalization, with no pre-existing lung pathology and no history of smoking. The patient did not get mechanical ventilation or chest trauma, but the possible cause could be severe alveolar inflammation. The CT results highlighted pneumonia in context with SARS-CoV-2 infection affecting about 50% of the pulmonary area. During hospitalization, lung lesions evolved 80% pulmonary damage associated with pneumomediastinum and subcutaneous emphysema. After three months, the patient completely recovered and the pneumomediastinum fully recovered with the complete disappearance of the lesions. Pneumomediastinum is a severe and rare complication in COVID-19 pneumonia, especially in male patients, without risk factors, and an early diagnosis can increase the chances of survival.
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Affiliation(s)
- Camelia Corina Pescaru
- Pulmonology Department, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Monica Steluța Marc
- Pulmonology Department, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Correspondence:
| | - Emanuela Oana Costin
- Pulmonology Department, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Andrei Pescaru
- ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Ana-Adriana Trusculescu
- Pulmonology Department, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Adelina Maritescu
- Pulmonology Department, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Noemi Suppini
- Pulmonology Department, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Cristian Iulian Oancea
- Pulmonology Department, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
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A Dangerous Duo: Spontaneous Pneumomediastinum and Venous Thromboembolism at Presentation in a Patient with COVID-19 Pneumonia. J Community Hosp Intern Med Perspect 2022; 12:13-18. [PMID: 35711864 PMCID: PMC9195119 DOI: 10.55729/2000-9666.1002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 09/29/2021] [Indexed: 01/09/2023] Open
Abstract
Background Coronavirus disease 2019 (Covid-19) is associated with spontaneous pneumomediastinum (SPM) predominantly in those after positive pressure ventilation (PPV) support. Additionally, many cases of venous thromboembolism (VTE) in COVID-19 patients were described. Our case is the first to describe SPM and VTE present on admission in a patient with Covid -19 pneumonia. Case report A 53-year-old man presented to the hospital with escalating dyspnea. Two weeks prior to this visit, he had been evaluated in an ambulatory setting and was started on antibiotics and systemic steroids. In the hospital, this patient was found to be in acute hypoxic respiratory failure and was placed on noninvasive PPV. Diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was confirmed by reverse transcriptase-polymerase chain reaction (RT-PCR) test from nasopharyngeal swab specimen. Chest computed tomography (CT) scan revealed multi-lobar pulmonary emboli (PE) and subcutaneous emphysema with pneumomediastinum. The patient was managed conservatively. He never required closed invasive mechanical ventilation. Subsequent serial imaging displayed the resolution of SPM. Conclusion The association between VTE and COVID-19 has been established. This report brings attention to SPM as an additional important complication of COVID-19, even in patients without pre-existing predisposing pathology or exposure to PPV.
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Chirurgie et COVID-19 : indications et résultats observés dans un hôpital tertiaire à Madagascar. REVUE DES MALADIES RESPIRATOIRES ACTUALITÉS 2022. [PMCID: PMC8709593 DOI: 10.1016/j.rmra.2021.11.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ghrenassia G, Nguyen A, Bedon Carte S. Dégradation respiratoire et COVID-19… Et si c’était un pneumomédiastin ? M�DECINE ET MALADIES INFECTIEUSES FORMATION 2022. [PMCID: PMC8815782 DOI: 10.1016/j.mmifmc.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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