COVID-19 - pneumomediastinum

Case contributed by Dr Fabio Macori

Presentation

Patient with no co-morbidities was admitted to hospital with a week history of fever, cough and SOB. The RT-PCR confirmed a SARS-CoV-2 infection.

Day 0

CT

CT performed at the admission shows the typical findings of Sars-CoV-2 infection. There is a bilateral subpleural, peripheral evidence of ground-glass opacities.

Day 7

CT

Due to an acute respiratory failure the patient underwent medical invasive ventilation.

There is an endotracheal tube in site.
A large pneumomediastinum with air decompressing along cervical fascial planes into the subcutaneous tissue. Diffuse ground-glass opacities (GGO) are still present bilaterally in all lobes with developing of areas of “crazy paving” increased density and, in the RUL, consolidations with a prevalent subpleural distribution.

Case Discussion

Respiratory failure is one of the worst complications occurring in patients with Sars-CoV-2 infection and can be life-threatening.

Treatment involves the use of mechanical ventilation, which may be non-invasive (through nasal or face mask, nasal plugs) or invasive (eg. use of endotracheal tube).
One of the complications that may appear in this type of treatment is pneumomediastinum secondary to alveolar rupture, which results in air leakage into the extra-alveolar interstitium.

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