COVID-19: spontaneous pneumomediastinum possible, indicating worsening illness

  • Zhou C, et al.
  • Lancet Infect Dis
  • 17 Mar 2020

  • curated by Liz Scherer
  • Clinical Essentials
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  • Chinese clinicians report the occurrence of spontaneous pneumomediastinum in a 38-year-old patient with confirmed COVID-19.
  • While the precise mechanism of spontaneous pneumomediastinum is unknown, it may cause severe circulatory and respiratory damage.

Why this matters

  • Closely monitor occurrence in COVID-19 patients as it may signal worsening disease.

Key points

  • 38-year-old male admitted to Central Hospital of Wuhan with 1-day history of fever without dizziness, cough, headaches.
  • Presentation: temperature, 38.1°C; C-reactive protein, 0.56 mg/dL; elevated leukocytes (10,060 cells/µL) and neutrophils (7550 cells/µL). 
  • Chest CT: multiple ground-glass opacities in lower lobes bilaterally.
  • At day 10, and following antibacterial, antiviral, and corticosteroid treatment, Reverse transcription (RT)-PCR confirmed COVID-19 in sputum samples. 
  • On day 11, patient developed exertional angina with cardiac palpitations and respiratory wheezing.
  • Chest CT: multiple ground-glass opacities with bilateral parenchymal consolidation and interlobular septal thickening.
  • Spontaneous pneumomediastinum, subcutaneous emphysema were also observed.
  • Management comprised continued ribavirin daily for 14 days, with added supplemental oxygen, antibiotics, antitussives, and bronchodilators, theophylline (0.2 g/12 hours), ambroxol (45 mg/12 hours), cefoperazone-tazobactam (2 g/8 hours) intravenously plus recombinant human interferon α-1b by aerosol 3 times a day for 14 days.
  • At day 25, temperature, cough, breathing improved to normal, RT-PCR negative, chest CT: resolution of previous pneumomediastinum, reduced parenchymal consolidation.
  • Patient was discharged on day 30 with negative RT-PCR.