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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2021; 31(S 01): S187-S191
DOI: 10.4103/ijri.IJRI_629_20
Case Report

Pneumomediastinum and subcutaneous emphysema as complication in COVID-19 patient with high CT severity score: Two case reports

Ravi R Kumar
Department of Radiology, Pulse Hitech Health Services, Borivali West, Mumbai, Maharashtra, India
,
Alok K Singhai
Department of Radiology, Pulse Hitech Health Services, Borivali West, Mumbai, Maharashtra, India
,
Shantanu V Lokare
Department of Medicine, Dhanashri Hospital, Borivali West, Mumbai, Maharashtra, India
,
Saumil P Pandya
Department of Radiology, Pulse Hitech Health Services, Borivali West, Mumbai, Maharashtra, India
› Author Affiliations Financial support and sponsorship Nil.
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Abstract

Coronavirus disease 2019 (COVID-19) is caused due to infection by severe acute respiratory syndrome virus coronavirus 2 (SARS-CoV-2). It is highly infective virus resulting in recent on-going pandemic and causing multisystem involvement predominantly affecting respiratory system. The most common presenting symptoms are fever, dry cough and breathlessness. The role of Computerized tomography (CT) is crucial especially in those patient having negative (rRT-PCR) but with high clinical suspicion, for prognosis and follow up. CT imaging findings mainly consists of multiple patchy bilateral ground-glass opacity (GGO) with or without consolidation and interlobular septal thickening with a peripheral or posterior distribution, mainly involving the lower lobes, depending upon the stage of disease. We present two case report of high CT severity score COVID-19 infection on non-invasive ventilation (NIV) having rare complication of pneumomediastinum and subcutaneous emphysema apart from typical COVID pattern lung findings during their course of admission in the hospital.

Keywords

Complications - COVID-19 - CT chest - pandemic - prognosis spontaneous pneumomediastinum - subcutaneous emphysema


Publication History

Received: 20 July 2020

Accepted: 22 October 2020

Article published online:
13 July 2021

© 2021. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Hui DS, Azhar EI, Madani TA, Ntoumi F, Kock R, Dar O. The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health – the latest 2019 novel coronavirus outbreak in Wuhan, China. Int J Infect Dis 2020; 91: 264-6
    CrossrefPubMedGoogle Scholar
  • 2 Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A. Coronavirus disease 2019 (COVID-19): A systematic review of imaging findings in 919 patients. AJR AM J Roentgenol 2020; 14: 1-7
    Google Scholar
  • 3 Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382: 1708-20
    CrossrefPubMedGoogle Scholar
  • 4 Letko M, Marzi A, Munster V. Functional assessment of cell entry and receptor usage for SARS-CoV-2 and other lineage B betacoronaviruses. Nat Microbiol 2020; 5: 562-9
    CrossrefPubMedGoogle Scholar
  • 5 Zheng YY, Ma YT, Zhang JY, Xie X. COVID-19 and the cardiovascular system. Nat Rev Cardiol 2020; 17: 259-60
    CrossrefPubMedGoogle Scholar
  • 6 Casey K, Iteen A, Nicolini R, Auten J. COVID-19 pneumonia with hemoptysis: Acute segmental pulmonary emboli associated with novel coronavirus infection. Am J Emerg Med 2020; 38: 1544.e1-3
    CrossrefPubMedGoogle Scholar
  • 7 Rogers J, Chesney E, Oliver D, Pollak TA, McGuire P, Fusar-Poli P. et al. Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: A systematic review and meta-analysis with comparison to the COVID-19 pandemic. Lancet Psychiatry 2020; 7: 611-27
    CrossrefPubMedGoogle Scholar
  • 8 Wu Y, Xu X, Chen Z, Duan J, Hashimoto K, Yang L. et al. Nervous system involvement after infection with COVID-19 and other coronaviruses. Brain Behav Immun 2020; 87: 18-22
    CrossrefPubMedGoogle Scholar
  • 9 Xie X, Zhong Z, Zhao W, Zheng C, Wang F, Liu J. Chest CT for typical 2019-nCoV pneumonia: Relationship to negative RT-PCR testing. Radiology 2020; 296: E41-5
    CrossrefPubMedGoogle Scholar
  • 10 Perlman S. Another decade, another coronavirus. N Engl J Med 2020; 382: 760-2
    CrossrefPubMedGoogle Scholar
  • 11 Jeffrey PK, Brent PL, Jonathan HC, Brett ME, Loren HK. Essentials for radiologists on COVID-19: An update—radiology scientific expert panel. Radiology 2020; 296: E113-4
    CrossrefPubMedGoogle Scholar
  • 12 Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J. et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA 2020; 323: 1061-9
    CrossrefPubMedGoogle Scholar
  • 13 Pan F, Ye T, Sun P, Gui S, Liang B, Li L. et al. Time course of lung changes on chest CT during recovery from 2019 novel coronavirus (COVID-19) pneumonia. Radiology 2020; 295: 715-21
    CrossrefPubMedGoogle Scholar
  • 14 Shi H, Han X, Jiang N, Cao Y, Osamah A, Gu J. et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: A descriptive study. Lancet Infect Dis 2020; 20: 425-34
    CrossrefPubMedGoogle Scholar
  • 15 Wei Z, Zheng Z, Xingzhi X, Qizhi Y, Jun L. Relation between chest CT findings and clinical conditions of coronavirus disease (COVID-19) pneumonia: A multicenter study. AJR 2020; 214: 1072-7
    CrossrefPubMedGoogle Scholar
  • 16 Pan Y, Guan H, Zhou S, Wang Y, Li Q, Zhu T. et al. Initial CT findings and temporal changes in patients with the novel coronavirus pneumonia (2019-nCoV): A study of 63 patients in Wuhan, China. Eur Radiol 2020; 30: 3306-9
    CrossrefPubMedGoogle Scholar
  • 17 Rodrigues JC, Hareb SS, Edeyc A, Devarajd A, Jacobe J, Johnstoneg A. et al. An update on COVID-19 for the radiologist-A British society of Thoracic Imaging statement. Clin Radiol 2020; 75: 323-5
    CrossrefPubMedGoogle Scholar
  • 18 Sahn SA, Heffner JE. Spontaneous pneumothorax. N Engl J Med 2000; 342: 868-74
    CrossrefPubMedGoogle Scholar
  • 19 Dehnadi A, Ebrahimi H, Karkan MF, Jahromi SK, Maafi AA. et al. Classification and management of subcutaneous emphysema: A 10-year experience. Indian J Surg 2015; 77: 673-7
    CrossrefPubMedGoogle Scholar
  • 20 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
    CrossrefPubMedGoogle Scholar
  • 21 Vinuta M, Rana AT. Spontaneous pneumomediastinum in COVID-19. BMJ Case Rep 2020; 13: e236519
    CrossrefPubMedGoogle Scholar
  • 22 Changyu Z, Chen G, Yuanliang X, Maosheng X. COVID-19 with spontaneous pneumomediastinum. Lancet Infect Dis 2020; 20: 510
    CrossrefPubMedGoogle Scholar
  • 23 Wang W, Gao R, Zheng Y, Jiang L. COVID-19 with spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema. J Travel Med 2020; 27: taaa062 DOI: 10.1093/jtm/taaa062.
    CrossrefPubMedGoogle Scholar
  • 24 Sylvie K, Nawfal H, Meryem H, Youssef A, Meryem B, Mounia S. et al. Spontaneous pneumomediastinum occurring in the SARS-COV-2 infection. IDCases 2020; 21: e00806
    CrossrefPubMedGoogle Scholar
  • 25 Jesse ML, María LP, Aurea DT, Silvia OV. Pneumomediastinum and spontaneous pneumothorax as an extrapulmonary complication of COVID-19 disease Emerg Radiol 2020:1-4. doi: 10.1007/s10140-020-01806-0.
  • 26 Marco F, Franco I, Giorgio MM, Simona C, Francesco C, Lucia M. et al. Chest CT score in COVID-19 patients: Correlation with disease severity and short-term prognosis. Eur Radiol. 2020;1-10. doi: 10.1007/s00330-020-07033.