Pneumomediastinum as a complication of COVID-19 pneumonia – self-experience study

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Introduction: Pneumomediastinum, defined as the presence of free air into the mediastinum, is a rare thoracic pathological condition. The aim of this research is to present pneumomediastinum as a complication of COVID-19 pneumonia, based on our first surveillance. Materials and Methods: We present three patients (hospitalized from August to December 2020) with COVID-19 pneumonia and pneumomediastinum: a 78-year-old woman and two men (aged: 58 and 75 years). The diagnosis of COVID-19 was carried out by real-time reverse transcriptive polymerase chain reaction. Pneumonia and pneumomediastinum were established by X-Ray and chest computed tomography. Results: The presenting woman developed pneumomediastinum on 12th day of mechanical ventilation (due to state of acute respiratory distress syndrome) with exitus on the 23rd day. For the two men, COVID-19 pneumonia was treated without intensive respiratory support [the 58-year-old man: pneumomediastinum was observed on the 16th day of coronavirus infection with exitus on the 31st day; the 75-year-old patient: pneumomediastinum developed on the 18th day and the patient was discharged after 39 days]. Conclusion: With this research we present a rare complication of COVID-19 pneumonia - pneumomediatinum, with two forms: without precipitating factor (spontaneous) and with precipitating factor (eg. mechanical ventilation). Due to the limited number of reported cases, the role of pneumomediastinum as a risk factor for a patient’s death in COVID-19 pneumonia is still debatable.

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