Clinical Image

Spontaneous pneumomediastinum COVID-19: Impact of mechanical ventilation

Rita Oze Koudouhonon¹

Suzanne Rita Aubin Igombe²

Biziman Wilson³

Hounayda Jerguigue⁴

Rachida Latib⁵

Youssef Omor⁶

¹ Resident in Radiology, Department of Radiology, National Institute of Oncology, UHC Ibn Sina, Rabat, Morocco

² Resident in Radiology, Department of Radiology, National Institute of Oncology, UHC Ibn Sina, Rabat, Morocco

³ Resident in Radiology, Department of Radiology, National Institute of Oncology, UHC Ibn Sina, Rabat, Morocco

⁴ Specialist in Radiology at Department of Radiology, National Institute of Oncology, UHC Ibn Sina, Rabat, Morocco

⁵ Professor Chief of the Radiology, Department Oncology, National Institute UHC Ibn Sina, Rabat, Morocco

⁶ Professor, Department of Radiology, National Institute of Oncology, UHC Ibn Sina, Rabat, Morocco

Address correspondence to:

Suzanne Rita Aubin Igombe

MO, Radiology Resident, Department of Radiology, National Institute of Oncology, UHC Ibn Sina, Rabat,

Morocco

Access full text article on other devices

Access PDF of article on other devices

Article ID: 100098Z06SI2021

doi: 10.5348/100098Z06SI2021CI

How to cite this article

Koudouhonon RO, Igombe SRA, Wilson B, Jerguigue H, Latib R, Omor Y. Spontaneous pneumomediastinum COVID-19: Impact of mechanical ventilation. Case Rep Int 2021;10:100098Z06RK2021.

ABSTRACT

No Abstract

Keywords: Computed tomography, COVID-19, Diagnosis, Pneumomediastinum

CASE REPORT

Coronavirus disease 2019 (COVID-19) has spread rapidly around the world and many studies have shown these typical and rare atypical findings, such as transient pneumothorax, spontaneous pneumomediastinum (SP), as well as emphysema subcutaneous during hospitalization.

This is the case in a 56-year-old woman with COVID-19, who presented during hospitalization, a spontaneous pneumomediastinum of low abundance. As her clinic worsened with dyspnea and impaired consciousness, she was put on mechanical ventilation in intensive care. Faced with the persistent symptomatology, a control thoracic computed tomography (CT) at 15 days of assisted ventilation found on the axial slice (Figure 1B) in parenchymal window, bilateral diffuse depoli glass areas with septal thickening, pneumomediastinum, and significant subcutaneous emphysema. Unfortunately our patient died a few days later.

Figure 1: (A) Topogram, (B) Thoracic CT, axial slice by parenchymal window, showing areas of bilateral diffuse glass depoli with septal thickening (red arrow), pneumomediastinum (yellow arrowhead), and a large subcutaneous emphysema (blue star).

DISCUSSION

Although the exact mechanism is unknown, the literature reports that an increase in alveolar pressure and the weakening of their walls related to the pronounced cough background in COVID-19 pneumonia make them more susceptible to rupture. Barotrauma has also been reported, linked to mechanical ventilation which in some cases could increase the pneumomediastinum and pre-existing emphysema [1],[2],[3],[4].

CONCLUSION

According to the literature and the analysis of cases, pneumothorax and pneumomediastinum have a high mortality of 60%. Thus, it is necessary to pay attention because their identification and early management can reduce this rate.

REFERENCES

Mohan V, Tauseen RA. Spontaneous pneumomediastinum in COVID-19. BMJ Case Rep 2020;13(5):e236519. [CrossRef] [Pubmed] Back to citation no. 1

Shan S, Guangming L, Wei L, Xuedong Y. Spontaneous pneumomediastinum, pneumothorax and subcutaneous emphysema in COVID-19: Case report and literature review. Rev Inst Med Trop Sao Paulo 2020;62:e76. [CrossRef] [Pubmed] Back to citation no. 1

Goldman N, Ketheeswaran B. Wilson H. COVID-19-associated pneumomediastinum. Clin Med (Lond) 2020;20(4):e91–2. [CrossRef] [Pubmed] Back to citation no. 1

Quincho-Lopez A, Quincho-Lopez DL, Hurtado-Medina FD. Case report: Pneumothorax and pneumomediastinum as uncommon complications of COVID-19 pneumonia-literature review. Am J Trop Med Hyg 2020;103(3):1170–6. [CrossRef] [Pubmed] Back to citation no. 1

SUPPORTING INFORMATION

Author Contributions

Rita Oze Koudouhonon - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Suzanne Rita Aubin Igombe - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Biziman Wilson - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Hounayda Jerguigue - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Rachida Latib - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published

Youssef Omor - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Data Availability Statement

The corresponding author is the guarantor of submission.

Consent For Publication

Written informed consent was obtained from the patient for publication of this article.

Data Availability

All relevant data are within the paper and its Supporting Information files.

Competing Interests

Authors declare no conflict of interest.

Copyright

© 2024 Rita Oze Koudouhonon et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.