COVID-19 with spontaneous pneumothorax, pneumomediastinum, and subcutaneous emphysema in the intensive care unit: Two case reports

Abdulrahman Alharthy; Gultakin H Bakirova; Homaida Bakheet; Abdullah Balhamar; Peter G Brindley; Saleh A Alqahtani; Ziad A Memish; Dimitrios Karakitsos

doi:10.1016/j.jiph.2020.12.019

COVID-19 with spontaneous pneumothorax, pneumomediastinum, and subcutaneous emphysema in the intensive care unit: Two case reports

J Infect Public Health. 2021 Mar;14(3):290-292. doi: 10.1016/j.jiph.2020.12.019. Epub 2020 Dec 29.

Authors

Abdulrahman Alharthy¹, Gultakin H Bakirova², Homaida Bakheet³, Abdullah Balhamar⁴, Peter G Brindley⁵, Saleh A Alqahtani⁶, Ziad A Memish⁷, Dimitrios Karakitsos⁸

Affiliations

¹ Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia. Electronic address: a_almshal@hotmail.com.
² Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia.
³ Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia. Electronic address: homaidabakheet@hotmail.com.
⁴ Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia. Electronic address: abdullahbalhamar@gmail.com.
⁵ Critical Care Department, The University of Alberta School of Medicine and Dentistry, Alberta, Canada. Electronic address: Peter.Brindley@albertahealthservices.ca.
⁶ Department of Medicine, The Johns Hopkins University Hospital, Baltimore, MD, USA. Electronic address: salqaht1@jhmi.edu.
⁷ Research & Innovation Centre, King Saud Medical City, Riyadh, Saudi Arabia. Electronic address: zmemish@yahoo.com.
⁸ Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia; Critical Care Department. Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. Electronic address: karakitsosdimitrios@gmail.com.

Abstract

Real-Time-reverse-transcription-Polymerase-Chain-Reaction from nasopharyngeal swabs and chest computed tomography (CT) depicting typically bilateral ground-glass opacities with a peripheral and/or posterior distribution are mandatory in the diagnosis of COVID-19. COVID-19 pneumonia may present though with atypical features such as pleural and pericardial effusions, lymphadenopathy, cavitations, and CT halo sign. In these two case-reports, COVID-19 presented as pneumothorax, pneumomediastinum and subcutaneous emphysema in critically ill patients. These disorders may require treatment or can be even self-limiting. Clinicians should be aware of their potential effects on the cardiorespiratory status of critically ill COVID-19 patients. Finally, pneumothorax can be promptly diagnosed by means of lung ultrasound. Although operator dependent, lung ultrasound is a useful bedside diagnostic tool that could alleviate the risk of cross-infection related to COVID-19 patient transport.

Keywords: COVID-19; Chest computed tomography; Lung ultrasound; Pneumomediastinum; Pneumothorax; Subcutaneous emphysema.

Publication types

Case Reports

MeSH terms

COVID-19 / complications*
Humans
Intensive Care Units
Male
Mediastinal Emphysema* / diagnostic imaging
Mediastinal Emphysema* / virology
Middle Aged
Pneumothorax* / diagnostic imaging
Pneumothorax* / virology
Subcutaneous Emphysema* / diagnostic imaging
Subcutaneous Emphysema* / virology