Asfand yar Butt, M.D.
Resident Physcian
Conemaugh Memorial Medical Center
JOHNSTOWN, Pennsylvania, United States
Disclosure information not submitted.
Asfand yar Butt, M.D.
Resident Physcian
Conemaugh Memorial Medical Center
JOHNSTOWN, Pennsylvania, United States
Disclosure information not submitted.
Talha Mehmood, MD
Attending Physician
Conemaugh Memorial Medical Center, United States
Disclosure information not submitted.
Title: COVID 19 associated Spontaneous Pneumomediastinum and Pneumopericardium
Introduction: Even though SARS-COV-19 began ravaging the world in December 2019, we have come a long way in researching the impact of the virus on the respiratory system. This abstract is describing another rare complication that may be associated with the disease caused by the novel corona virus. Spontaneous pneumothorax (SPT) and pneumo-mediastinum (SPM) is generally a complication of blunt trauma or intrinsic lung diseases such as Asthma or Bronchiolitis Obliterans, seen as a direct complication of air leaking into surrounding closed structures from either the pulmonary system or esophagus. This was found unusually in multiple patients admitted with severe COVID-19 pneumonia.
CASE SERIES: Descriptive analysis of 3 independent cases of severe COVID 19 pneumonia who developed both SPM and SPT before deteriorating to requiring invasive ventilation. Further evaluation also ruled out any esophageal trauma as the source and warranted input from Cardiothoracic Surgery for possible intervention. All patients continued to worsen either requiring ECMO and/or a higher facility care or were made comfort care only, by the family.
Discussion: Several studies have indicated COVID-19 prolonging beyond 2 weeks can be a direct risk factor for getting SPM and SPT [1]. This can be explained by the observation that patients with severe COVID earlier tend to have a higher chance of accelerated lung fibrosis, increasing the vulnerability of the alveolar tissue to leak air into the surrounding space. Adding onto this, patients developing these complications have documented worsened morbidity and mortality [2].
CONCLSUION: SPT and SPM need to be in consideration not just as a possible complication of severe COVID-19 disease but also an indicator of poor prognosis.
References:
1. Chu CM, Leung YY, Hui JY et al Spontaneous pneumomediastinum in patients with severe acute respiratory syndrome. Eur Respir J. 2004 Jun;23(6):802-4. doi: 10.1183/09031936.04.00096404. PubMed PMID: 15218989.
2.Loffi M, Regazzoni V, Sergio P et al Spontaneous pneumomediastinum in COVID-19 pneumonia. Monaldi Arch Chest Dis. 2020 Sep 29;90(4). doi: 10.4081/monaldi.2020.1399. PubMed PMID: 32990690.