https://doi.org/10.4081/monaldi.2022.2338
Pneumomediastinum in the COVID-19 era: to drain or not to drain?
Submitted: June 1, 2022
Accepted: July 20, 2022
Published: July 27, 2022
Accepted: July 20, 2022
Abstract Views: 1065
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Pneumomediastinum (PNM) is a rare clinical finding, usually with a benign course, which is managed conservatively in the majority of cases. However, during the COVID-19 pandemic, an increased incidence of PNM has been observed. Several reports of PNM cases in COVID-19 have been reported in the literature and were managed either conservatively or surgically. In this study, we present our institutional experience of COVID-19 associated PNM, propose a management algorithm, and review the current literature. In total, 43 Case Series were identified, including a total of 747 patients, of whom 374/747 (50.1%) were intubated at the time of diagnosis, 168/747 (22.5%) underwent surgical drain insertion at admission, 562/747 (75.2%) received conservative treatment (observation or mechanical ventilation. Inpatient mortality was 51.8% (387/747), while 45.1% of the population recovered and/or was discharged (337/747). In conclusion, with increased incidence of PNM in COVID-19 patients reported in the literature, it is still difficult to assign a true causal relationship between PNM and mortality. We can, however, see that PMN plays an important role in disease prognosis. Due to increased complexity, high mortality, and associated complications, conservative management may not be sufficient, and a surgical approach is needed.
Giannos P, Katsikas Triantafyllidis K, et al. Persistent hiccups as an atypical presentation of SARS-CoV-2 infection: a systematic review of case reports. Front Neurol 2022;13:1–11.
DOI: https://doi.org/10.3389/fneur.2022.819624
Katsikas Triantafyllidis K, Giannos P, Mian IT, et al. Varicella zoster virus reactivation following COVID-19 vaccination: a systematic review of case reports. Vaccines 2021;9:1013.
DOI: https://doi.org/10.3390/vaccines9091013
Dolhnikoff M, Duarte-Neto AN, de Almeida Monteiro RA, et al. Pathological evidence of pulmonary thrombotic phenomena in severe COVID-19. J Thromb Haemos 2020;18:1517–9.
DOI: https://doi.org/10.1111/jth.14844
Park SJ, Park JY, Jung J, Park SY. Clinical manifestations of spontaneous pneumomediastinum. Korean J Thorac Cardiovasc Surg 2016;49:287–91.
DOI: https://doi.org/10.5090/kjtcs.2016.49.4.287
Takada K, Matsumoto S, Hiramatsu T, et al. Spontaneous pneumomediastinum: an algorithm for diagnosis and management. Ther Adv Respir Dis 2009;3:301–7.
DOI: https://doi.org/10.1177/1753465809350888
Iyer VN, Joshi AY, Ryu JH. Spontaneous pneumomediastinum: analysis of 62 consecutive adult patients. Mayo Clin Proc 2009;84:417–21.
DOI: https://doi.org/10.4065/84.5.417
Mondello B, Pavia R, Ruggeri P et al. Spontaneous pneumomediastinum: experience in 18 adult patients. Lung 2007;185:9–14.
DOI: https://doi.org/10.1007/s00408-006-0002-7
Melhorn J, Achaiah A, Conway FM et al. Pneumomediastinum in COVID-19: a phenotype of severe COVID-19 pneumonitis? The results of the United Kingdom (POETIC) survey. Eur Respir J 2022;2102522. Online ahead of print.
DOI: https://doi.org/10.1183/13993003.02522-2021
Kouritas VK, Papagiannopoulos K, Lazaridis G et al. Pneumomediastinum. J Thorac Dis 2015;7:S44-49.
Takada K, Matsumoto S, Hiramatsu T, et al. Management of spontaneous pneumomediastinum based on clinical experience of 25 cases. Respir Med 2008;102:1329–34.
DOI: https://doi.org/10.1016/j.rmed.2008.03.023
Chu CM, Leung YY, Hui JYH et al. Spontaneous pneumomediastinum in patients with severe acute respiratory syndrome. Eur Respir J 2004;23:802–4.
DOI: https://doi.org/10.1183/09031936.04.00096404
Perna V, Vilà E, Guelbenzu JJ, Amat I. Pneumomediastinum: is this really a benign entity? When it can be considered as spontaneous? Our experience in 47 adult patients. Eur J Cardiothorac Surg 2010;37:573–5.
DOI: https://doi.org/10.1016/j.ejcts.2009.08.002
Gralinski LE, Baric RS. Molecular pathology of emerging coronavirus infections. J Pathol 2015;235:185–95.
DOI: https://doi.org/10.1002/path.4454
Kooraki S, Hosseiny M, Myers L, Gholamrezanezhad A. Coronavirus (COVID-19) outbreak: what the department of radiology should know. J Am Coll Radiol 2020;17:447-51.
DOI: https://doi.org/10.1016/j.jacr.2020.02.008
Mohan V, Tauseen RA. Spontaneous pneumomediastinum in COVID-19. BMJ Case Rep 2020;13:e236519.
DOI: https://doi.org/10.1136/bcr-2020-236519
Wang J, Su X, Zhang T, Zheng C. Spontaneous pneumomediastinum: a probable unusual complication of coronavirus disease 2019 (COVID-19) pneumonia. Korean J Radiol 2020;21:627-8.
DOI: https://doi.org/10.3348/kjr.2020.0281
Lei P, Mao J, Wang P. Spontaneous pneumomediastinum in a patient with coronavirus disease 2019 pneumonia and the possible underlying mechanism. Korean J Radiol 2020;21:929–30.
DOI: https://doi.org/10.3348/kjr.2020.0426
Romano N, Fischetti A, Melani EF. Pneumomediastinum related to COVID-19 pneumonia. Am J Med Sci 2020;360:e19–20.
DOI: https://doi.org/10.1016/j.amjms.2020.06.003
Eperjesiova B, Hart E, Shokr M et al. Spontaneous pneumomediastinum/pneumothorax in patients with COVID-19. Cureus 2020;12:10–3.
DOI: https://doi.org/10.7759/cureus.8996
Kolani S, Houari N, Haloua M, et al. Spontaneous pneumomediastinum occurring in the SARS-COV-2 infection. IDCases 2020;21:e00806.
DOI: https://doi.org/10.1016/j.idcr.2020.e00806
Sun R, Liu H, Wang X. Mediastinal emphysema, giant bulla, and pneumothorax developed during the course of COVID-19 pneumonia. Korean J Radiol 2020;21:541–4.
DOI: https://doi.org/10.3348/kjr.2020.0180
Spiro JE, Sisovic S, Ockert B, et al. Secondary tension pneumothorax in a COVID-19 pneumonia patient: a case report. Infection 2020;48:941–4.
DOI: https://doi.org/10.1007/s15010-020-01457-w
Flower L, Carter JPL, Rosales Lopez J, Henry AM. Tension pneumothorax in a patient with COVID-19. BMJ Case Rep. 2020;13:e235861.
DOI: https://doi.org/10.1136/bcr-2020-235861
López Vega JM, Parra Gordo ML, Diez Tascón A, Ossaba Vélez S. Pneumomediastinum and spontaneous pneumothorax as an extrapulmonary complication of COVID-19 disease. Emerg Radiol 2020;27:727–30.
DOI: https://doi.org/10.1007/s10140-020-01806-0
Ucpinar BA, Sahin C, Yanc U. Spontaneous pneumothorax and subcutaneous emphysema in COVID-19 patient: Case report. J Infect Public Health 2020;13:887–9.
DOI: https://doi.org/10.1016/j.jiph.2020.05.012
Al-Azzawi M, Douedi S, Alshami A, et al. Spontaneous subcutaneous emphysema and pneumomediastinum in COVID-19 patients: An indicator of poor prognosis? Am J Case Rep 2020;21:1–6.
DOI: https://doi.org/10.12659/AJCR.925557
Loffi M, Regazzoni V, Sergio P, et al. Spontaneous pneumomediastinum in COVID-19 pneumonia. Monaldi Arch Chest Dis. 2020;90:604–7.
DOI: https://doi.org/10.4081/monaldi.2020.1399
Cuker A, Peyvandi F. COVID-19: hypercoagulability. UpToDate; 2022. Available from: https://www.uptodate.com/contents/covid-19-hypercoagulability
Larrey DJ. New surgical procedure to open the pericardium in case of fluid in its cavity. Clin Chir.1829;2:303–7.
DOI: https://doi.org/10.1056/NEJM182906230021908
Ogle C, Allingham H. A suggestion for a method of opening the pericardial sac, founded upon a case of purulent pericarditis. Lancet1900;155:693–5.
DOI: https://doi.org/10.1016/S0140-6736(01)95428-5
Motas C, Motas N, Rus O, Horvat T. Left paraxiphoidian approach for drainage of pericardial effusions. Interact Cardiovasc Thorac Surg 2010;10:4–5.
DOI: https://doi.org/10.1510/icvts.2009.211250
Wang H, Paulson KR, Pease SA, et al. Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020-21. Lancet 2022;399:1513–36.
DOI: https://doi.org/10.1016/S0140-6736(21)02796-3
Udwadia ZF, Toraskar KK, Pinto L, et al. Increased frequency of pneumothorax and pneumomediastinum in COVID-19 patients admitted in the ICU: A multicentre study from Mumbai, India. Clin Med (Northfield Il) 2021;21:e615–9.
DOI: https://doi.org/10.7861/clinmed.2021-0220
Office of National Statistics. Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK: 1 April 2021. 2021. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/prevalenceofongoingsymptomsfollowingcoronaviruscovid19infectionintheuk/1april2021
Duzgun SA, Durhan G, Demirkazik FB et al. COVID-19 pneumonia: the great radiological mimicker. Insights Imaging 2020;11:1–15.
DOI: https://doi.org/10.1186/s13244-020-00933-z
Gibson PG, Qin L, Puah SH. COVID‐19 acute respiratory distress syndrome (ARDS): clinical features and differences from typical pre‐COVID‐19 ARDS. Med J Aust 2020;213:54–6.
DOI: https://doi.org/10.5694/mja2.50674
Mayhew D, Mendonca V, Murthy BVS. A review of ASA physical status - historical perspectives and modern developments. Anaesthesia 2019;74:373–9.
DOI: https://doi.org/10.1111/anae.14569
Fitch MT, Nicks BA, Pariyadath M, et al. Emergency pericardiocentesis. N Engl J Med 2012;366:e17.
DOI: https://doi.org/10.1056/NEJMvcm0907841
Gorospe L, Ayala-Carbonero A, Ureña-Vacas A, et al. Spontaneous pneumomediastinum in patients with COVID-19: a case series of four patients. Arch Bronconeumol 2020;56:754–6.
DOI: https://doi.org/10.1016/j.arbr.2020.06.004
Reyes S, Roche B, Kazzaz F, et al. Pneumothorax and pneumomediastinum in COVID-19: A case series. Am J Med Sci 2022;363:548–51.
DOI: https://doi.org/10.1016/j.amjms.2020.11.024
Manna S, Maron SZ, Cedillo MA, et al. Spontaneous subcutaneous emphysema and pneumomediastinum in non-intubated patients with COVID-19. Clin Imaging 2020;67:207–13.
DOI: https://doi.org/10.1016/j.clinimag.2020.08.013
Volpi S, Ali JM, Suleman A, Ahmed RN. Pneumomediastinum in COVID-19 patients: A case series of a rare complication. Eur J Cardiothorac Surg 2020;58:646–7.
DOI: https://doi.org/10.1093/ejcts/ezaa222
Suwanwongse K, Shabarek N. Pneumomediastinum in mechanically ventilated coronavirus disease 2019 patients. J Cardiothorac Vasc Anesth 2021;35:686–8.
DOI: https://doi.org/10.1053/j.jvca.2020.06.058
Wadhawa R, Thakkar A, Chhanwal H, et al. Spontaneous pneumomediastinum and subcutaneous emphysema in patients with COVID-19. Saudi J Anaesth 2021;15:93–6.
DOI: https://doi.org/10.4103/sja.sja_939_20
Oye M, Ali A, Kandah F, Chowdhury N. Two cases of spontaneous pneumomediastinum with pneumothorax in patients with COVID-19 associated pneumonia. Respir Med Case Rep 2020;31:101308.
DOI: https://doi.org/10.1016/j.rmcr.2020.101308
Mallick T, Dinesh A, Engdahl R, Sabado M. COVID-19 complicated by spontaneous pneumothorax. Cureus 2020;12:1–6.
DOI: https://doi.org/10.7759/cureus.9104
Wali A, Rizzo V, Bille A, et al. Pneumomediastinum following intubation in COVID-19 patients: a case series. Anaesthesia 2020;75:1076–81.
DOI: https://doi.org/10.1111/anae.15113
Brogna B, Bignardi E, Salvatore P, et al. Unusual presentations of COVID-19 pneumonia on CT scans with spontaneous pneumomediastinum and loculated pneumothorax: a report of two cases and a review of the literature. Hear Lung 2020;49:864–8.
DOI: https://doi.org/10.1016/j.hrtlng.2020.06.005
Juárez-Lloclla JP, León-Jiménez F, Urquiaga-Calderón J, et al. Spontaneous pneumopericardium and pneumomediastinum in twelve COVID-19 patients. Arch Bronconeumol 2021;57:86–8.
DOI: https://doi.org/10.1016/j.arbres.2020.09.013
Rafiee MJ, Babaki Fard F, Samimi K, et al. Spontaneous pneumothorax and pneumomediastinum as a rare complication of COVID-19 pneumonia: report of 6 cases. Radiol Case Rep 2021;16:687–92.
DOI: https://doi.org/10.1016/j.radcr.2021.01.011
Protrka MR, Ivanac G, Đudarić L, et al. Spontaneous pneumomediastinum, pneumothorax and subcutaneous emphysema: radiological aspects of rare COVID-19 complications in 3 patients. Radiol Case Rep 2021;16:3237–43.
DOI: https://doi.org/10.1016/j.radcr.2021.07.089
Tacconi F, Rogliani P, Leonardis F, et al. Incidence of pneumomediastinum in COVID-19: a single-center comparison between 1st and 2nd wave. Respir Investig 2021;59:661–5.
DOI: https://doi.org/10.1016/j.resinv.2021.04.010
Iuorio A, Nagar F, Attianese L, et al. Spontaneous pneumomediastinum and pneumothorax in nonintubated COVID-19 patients: A multicenter case series. Am J Case Rep 2021;22:1–5.
DOI: https://doi.org/10.12659/AJCR.933405
Machiraju PK, Alex NM, Safinaaz, Baby NM. Pneumomediastinum in COVID-19: a series of three cases and review of literature. SAGE Open Med Case Rep 2021;29:1–6.
DOI: https://doi.org/10.1177/2050313X211011807
Diaz A, Patel D, Sayedy N, Anjum F. COVID-19 and spontaneous pneumomediastinum: a case series. Heart Lung 2021;50:202–5.
DOI: https://doi.org/10.1016/j.hrtlng.2020.12.002
Jamil AK, Alam A, Youssef RM, et al. Pneumothorax and pneumomediastinum in COVID-19 suggest a pneumocystic pathology. Mayo Clin Proc Innov Qual Outcomes 2021;5:827–34.
DOI: https://doi.org/10.1016/j.mayocpiqo.2021.05.009
Adhikary AB, Udhyachander R, Patel NB, et al. Spectrum of pneumothorax/pneumomediastinum in patients with coronavirus disease 2019. Qatar Med J 2021;2021:1–11.
DOI: https://doi.org/10.5339/qmj.2021.41
Sabharwal P, Chakraborty S, Tyagi N, et al. Spontaneous air-leak syndrome and COVID-19: a multifaceted challenge. Indian J Crit Care Med 2021;25:584–7.
DOI: https://doi.org/10.5005/jp-journals-10071-23819
Sethi SM, Ahmed AS, Hanif S, et al. Subcutaneous emphysema and pneumomediastinum in patients with COVID-19 disease; case series from a tertiary care hospital in Pakistan. Epidemiol Infect 2021;149:1–8.
DOI: https://doi.org/10.1017/S095026882100011X
Damous SHB, dos Santos Junior JP, Pezzano ÁVA, et al. Pneumomediastinum complicating COVID-19: a case series. Eur J Med Res 2021;26:1–6.
DOI: https://doi.org/10.1186/s40001-021-00585-9
Edwards J-A, Breitman I, Bienstock J, et al. Pulmonary barotrauma in mechanically ventilated coronavirus disease 2019 patients: a case series. Ann Med Surg 2021;61:24-9.
DOI: https://doi.org/10.1016/j.amsu.2020.11.054
Rodriguez-Arciniega TG, Sierra-Diaz E, Flores-Martinez JA, et al. frequency and risk factors for spontaneous pneumomediastinum in COVID-19 patients. Front Med 2021;8:1–5.
DOI: https://doi.org/10.3389/fmed.2021.662358
Shaikh N, Al Ameri G, Shaheen M, et al. Spontaneous pneumomediastinum and pneumothorax in COVID-19 patients: a tertiary care experience. Health Sci Rep 2021;4:2–7.
DOI: https://doi.org/10.1002/hsr2.339
Udi J, Lang CN, Zotzmann V, et al. Incidence of barotrauma in patients with COVID-19 pneumonia during prolonged invasive mechanical ventilation – a case-control study. J Intensive Care Med 2021;36:477–83.
DOI: https://doi.org/10.1177/0885066620954364
Kalpaxi A, Kalokairinou M, Katseli P, et al. Spontaneous pneumomediastinum and COVID-19 pneumonia: report of three cases with emphasis on CT imaging. Radiol Case Reports. 2021;16:2586–92.
DOI: https://doi.org/10.1016/j.radcr.2021.06.040
Kangas-Dick A, Gazivoda V, Ibrahim M, et al. Clinical characteristics and outcome of pneumomediastinum in patients with COVID-19 pneumonia. J Laparoendosc Adv Surg Tech 2021;31:273–8.
DOI: https://doi.org/10.1089/lap.2020.0692
Mangel TP, Madden BP. Acute tracheal tear – a potential cause of spontaneous pneumomediastinum in patients with COVID-19. Monaldi Arch Chest Dis 2021;91:1852.
DOI: https://doi.org/10.4081/monaldi.2021.1852
Kabi A, Kaeley N, Shankar T, et al. COVID-19-associated pneumomediastinum and pneumothorax: a case series. Cureus 2021;13:1–9.
DOI: https://doi.org/10.7759/cureus.17715
Haberal MA, Akar E, Dikis OS, et al. Spontaneous pneumomediastinum incidence and clinical features in non-intubated patients with COVID-19. Clinics 2021;76:1–5.
DOI: https://doi.org/10.6061/clinics/2021/e2959
Cut TG, Tudoran C, Lazureanu VE, et al. Spontaneous pneumomediastinum, pneumothorax, pneumopericardium and subcutaneous emphysema—not so uncommon complications in patients with covid-19 pulmonary infection—a series of cases. J Clin Med 2021;10:1–7.
DOI: https://doi.org/10.3390/jcm10071346
Coppola MG, Lugarà M, Tamburrini S, et al. Pneumomediastinum and pneumothorax as relevant complications of sub-intensive care of patients with COVID-19: description of a case series. Medicina (Kaunas) 2021;57:919.
DOI: https://doi.org/10.3390/medicina57090919
Chen IE, Roth A, Thomas M, Pahwa A. Isolated spontaneous pneumomediastinum in COVID-19 patients: case series and review of the literature. J Med Imaging Case Rep 2021;5:15-21.
DOI: https://doi.org/10.17756/micr.2021-065
Gandolfo C, Bonfiglio M, Spinetto G, et al. Pneumomediastinum associated with severe pneumonia related to COVID-19: diagnosis and management. Minerva Med 2022;112:686–8.
DOI: https://doi.org/10.23736/S0026-4806.21.07585-6
Özdemir S, Bilgi DÖ, Hergünsel GO, Çitak N. Incidence and risk factors for pneumomediastinum in COVID-19 patients in the intensive care unit. Interact Cardiovasc Thorac Surg 2022;34:236–44.
DOI: https://doi.org/10.1093/icvts/ivab258
Reis AE, Emami N, Chand S, et al. Epidemiology, risk factors and outcomes of pneumomediastinum in patients with coronavirus disease 2019: a case-control study. J Intensive Care Med 2022;37:12–20.
DOI: https://doi.org/10.1177/08850666211040417
How to Cite
Patel, Nian, Robert Nicolae, Georgios Geropoulos, Pallabhi Mandal, Chrysanthos D. Christou, Marianna Gavala, Nikolaos Madouros, et al. 2022. “Pneumomediastinum in the COVID-19 Era: To Drain or Not to Drain?”. Monaldi Archives for Chest Disease 93 (2). https://doi.org/10.4081/monaldi.2022.2338.
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