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The American Journal of Case Reports Jul 2020BACKGROUND Novel Coronavirus 2019 (COVID-19) has been in the spotlight since the first cases were reported in December 2019. COVID-19 has been found to cause severe...
BACKGROUND Novel Coronavirus 2019 (COVID-19) has been in the spotlight since the first cases were reported in December 2019. COVID-19 has been found to cause severe acute respiratory distress syndrome and, more uncommonly, subcutaneous emphysema and pneumomediastinum. We present a case series of 3 patients with COVID-19 infection managed in the Intensive Care Unit and found to have subcutaneous emphysema and pneumomediastinum on chest imaging. CASE REPORT We present a case series of 3 men, ages 36, 47, and 78 years, diagnosed with COVID-19 via RT-PCR, found to have severe acute respiratory distress syndrome, and managed in the Intensive Care Unit. Two patients described in this case series were mechanically ventilated on low positive end-expiratory pressures and developed subcutaneous emphysema and pneumomediastinum on chest imaging, and 1 patient developed subcutaneous emphysema prior to intubation. Each of these patients had a more eventful hospital course and worse outcomes than most COVID-19 infected patients. CONCLUSIONS Subcutaneous emphysema and pneumomediastinum in COVID-19 patients have been rarely reported and is poorly understood. In our institution, we have found the diagnosis of subcutaneous emphysema and pneumomediastinum in COVID-19 patients is associated with unfavorable outcomes and worse prognosis.
Topics: Adult; Aged; Betacoronavirus; COVID-19; Coronavirus Infections; Humans; Male; Mediastinal Emphysema; Middle Aged; Pandemics; Pneumonia, Viral; Prognosis; SARS-CoV-2; Subcutaneous Emphysema; Tomography, X-Ray Computed
PubMed: 32703927
DOI: 10.12659/AJCR.925557 -
Nigerian Journal of Clinical Practice Apr 2023Spontaneous pneumomediastinum (SPM) is defined as free air or gas in the mediastinum that is not associated with an obvious cause such as chest trauma. The SPM results... (Review)
Review
Spontaneous pneumomediastinum (SPM) is defined as free air or gas in the mediastinum that is not associated with an obvious cause such as chest trauma. The SPM results from acutely elevated intra-alveolar pressure: The high-pressure gradient between the distal alveoli and the pulmonary interstitium leads to alveolar rupture. This causes free gas to separate through the peribronchovascular fascial sheaths (interstitial emphysema) into the hilum and then into the mediastinum. Once the gas is in the mediastinum, it can travel up to the cervical soft tissues (even the retroperitoneum) producing subcutaneous emphysema. The Macklin effect appears on thoracic computed tomography (CT) as linear air collections adjacent to bronchovascular sheaths. This case report presents CT findings of SPM due to the Macklin effect in three cases and a brief literature review on this subject.
Topics: Humans; Mediastinal Emphysema; Neck; Pulmonary Alveoli; Subcutaneous Emphysema; Thoracic Injuries; Tomography, X-Ray Computed
PubMed: 37203121
DOI: 10.4103/njcp.njcp_901_22 -
BMJ Case Reports Sep 2021
Topics: Asthma; Emphysema; Humans; Mediastinal Emphysema; Subcutaneous Emphysema
PubMed: 34511418
DOI: 10.1136/bcr-2021-245712 -
Journal of Vascular and Interventional... Sep 2021
Topics: COVID-19; Humans; Male; Mediastinal Emphysema; Middle Aged; Pneumothorax; SARS-CoV-2; Tomography, X-Ray Computed
PubMed: 34157413
DOI: 10.1016/j.jvir.2021.06.003 -
Critical Care Medicine Jan 2023
Topics: Humans; Mediastinal Emphysema; COVID-19; Respiratory Distress Syndrome; SARS-CoV-2
PubMed: 36519990
DOI: 10.1097/CCM.0000000000005733 -
Polish Archives of Internal Medicine Mar 2020
Topics: Female; Humans; Mediastinal Emphysema; Subcutaneous Emphysema; Tooth Extraction; Young Adult
PubMed: 31944185
DOI: 10.20452/pamw.15145 -
Medicina (Kaunas, Lithuania) Oct 2022For COVID-19 pneumonia, many manifestations such as fever, dyspnea, dry cough, anosmia and tiredness have been described, but differences have been observed from person...
For COVID-19 pneumonia, many manifestations such as fever, dyspnea, dry cough, anosmia and tiredness have been described, but differences have been observed from person to person according to age, pulmonary function, damage and severity. In clinical practice, it has been found that patients with severe forms of infection with COVID-19 develop serious complications, including pneumomediastinum. Although two years have passed since the beginning of the pandemic with the SARS-CoV-2 virus and progress has been made in understanding the pathophysiological mechanisms underlying the COVID-19 infection, there are also unknown factors that contribute to the evolution of the disease and can lead to the emergence some complications. In this case report, we present a patient with COVID-19 infection who developed a massive spontaneous pneumomediastinum and subcutaneous emphysema during hospitalization, with no pre-existing lung pathology and no history of smoking. The patient did not get mechanical ventilation or chest trauma, but the possible cause could be severe alveolar inflammation. The CT results highlighted pneumonia in context with SARS-CoV-2 infection affecting about 50% of the pulmonary area. During hospitalization, lung lesions evolved 80% pulmonary damage associated with pneumomediastinum and subcutaneous emphysema. After three months, the patient completely recovered and the pneumomediastinum fully recovered with the complete disappearance of the lesions. Pneumomediastinum is a severe and rare complication in COVID-19 pneumonia, especially in male patients, without risk factors, and an early diagnosis can increase the chances of survival.
Topics: Humans; Male; Mediastinal Emphysema; COVID-19; SARS-CoV-2; Tomography, X-Ray Computed; Subcutaneous Emphysema
PubMed: 36363482
DOI: 10.3390/medicina58111525 -
Asian Journal of Surgery Oct 2005Retropharyngeal and mediastinal emphysema is associated with traumatic aerodigestive tract injury, and may be associated with potentially severe and even...
Retropharyngeal and mediastinal emphysema is associated with traumatic aerodigestive tract injury, and may be associated with potentially severe and even life-threatening complications. Retropharyngeal emphysema or pneumomediastinum, in the absence of severe trauma to the visceral organs, is rare following facial fractures. We report a case of extensive subcutaneous emphysema extending to the retropharyngeal space and mediastinum following an orbitozygomatic fracture.
Topics: Aged; Face; Female; Humans; Male; Mediastinal Emphysema; Middle Aged; Neck; Orbital Fractures; Pharyngeal Diseases; Radiography; Subcutaneous Emphysema
PubMed: 16234086
DOI: 10.1016/S1015-9584(09)60367-5 -
Thorax Sep 1996Two cases are reported of pneumomediastinum induced by the use of Ecstasy, a semi-synthetic hallucinogenic compound related to amphetamine and mescaline which has become...
Two cases are reported of pneumomediastinum induced by the use of Ecstasy, a semi-synthetic hallucinogenic compound related to amphetamine and mescaline which has become established as a recreational drug in the UK since the late 1980s. Both cases recovered without incident, but it is important that the possible complications of this drug be publicised so that at risk subjects can be diagnosed early and managed appropriately.
Topics: 3,4-Methylenedioxyamphetamine; Adolescent; Adult; Humans; Male; Mediastinal Emphysema; Substance-Related Disorders
PubMed: 8984713
DOI: 10.1136/thx.51.9.960 -
Digestive Diseases (Basel, Switzerland) 2000
Topics: Aged; Alcoholic Intoxication; Diagnosis, Differential; Esophageal Diseases; Humans; Male; Mediastinal Emphysema; Radiography; Rupture, Spontaneous
PubMed: 11185442
DOI: 10.1159/000016963