COVID-19 pneumonia with pneumomediastinum and extensive subcutaneous emphysema
Presentation
Known case of COVID 19 pneumonia admitted in isolation ward with complains of fever, cough and SOB.
Patient Data
Chest leads are applied.
There is extensive ill-defined air space opacification in both lungs, more so on the left side, in keeping with extensive bilateral pulmonary infection.
There is suggestion of pneumo-mediastinum. There is soft tissue emphysema in both supra-clavicular fossa and along both lateral chest walls.
Trachea is slightly deviated towards right side due to rotation.
Transverse cardiac diameter cannot be commented due to AP projection.
Right costophrenic angle is hazy, this may be due to rotation and overlying soft tissue shadow.
Left costophrenic angle is sharp. Curvilinear lucency is noted in left upper hemithorax with the suggestion of visible visceral pleural line, this is suspicious of small pneumothorax. X-ray left up decubitus is recommended for further evaluation.
Mild degenerative changes are noted in visualized skeleton.
Extensive bilateral ground glass opacification noted in both lungs with consolidation in both lower lobes, due to known COVID-19 pneumonia.
Evidence of extensive pneumomediastinum extending to the soft tissues of neck and anterolateral chest wall. Small right sided pneumothorax is present. Streaky left apical pneumothorax is also present.
Case Discussion
Severe strain during persistent cough in COVID-19 pneumonia can be the causative factor for pneumothorax. Consequentially pneumomediastinum and subcutaneous emphysema may also occur.
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