Presentation
Admitted with acute shortness of breath. PCR positive for COVID-19
Patient Data
Minor peripheral airspace change in the mid and lower zones, marginally worse on the left, highly suggestive of COVID pneumonitis.
Relatively mild, but more diffuse, airspace change in the right lung than on the radiograph 3 days earlier.
Appearances suggest progression of the known COVID pneumonitis.
Relatively stable appearances to the lung parenchyma since the radiograph 5 days prior.
A pneumomediastinum has developed in the interim with surgical emphysema in the soft tissues of the neck.
No pneumothorax.
Endotracheal and nasogastric tubes suitably sited.
Extensive bilateral airspace change in keeping with COVID pneumonia.
Moderate right-sided pneumothorax and pneumomediastinum.
Large volue surgical emphysema.
Case Discussion
This series of radiographs over a period of 10 days illustrate the progressive nature of COVID pneumonia and potential complications which may further complicate the disease process.
We have observed a number of cases of pneumomediastinum and or pneumothorax in those with prolonged stays and worse disease, even those without intubation.
The pneumomediastinum/pneumothorax may be due to the barotrauma from continuous positive airway pressure (CPAP) treatment.
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