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COVID-19 Pneumonia Associated With Spontaneous Pneumomediastinum and Pneumopericardium
Murillo Brito DA, Villalva CEA, Simón AS, Guisado-Clavero M. COVID-19 Pneumonia Associated With Spontaneous Pneumomediastinum and Pneumopericardium. June 2020. doi:10.25373/ctsnet.12485831
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which originated in Wuhan, China, is spreading around the world, and the outbreak continues to escalate. Clinical features of patients with coronavirus disease 2019 (COVID-19) usually include dry cough, fever, diarrhea, vomiting, and myalgia (1-2). However, atypical presentation and complications are described (3, 4). The authors report a case of pneumopericardium, pneumomediastinum, and subcutaneous emphysema associated with COVID-19.
A 58-year-old nonsmoking man was admitted to IFEMA COVID-19 field hospital with seven days of fever, occasional cough, and anosmia. Initial physical examination only showed bibasilar crackles. Chest X-ray showed bibasilar pneumonia. Analysis revealed mild lymphopenia, and moderate D-Dimer, PCR, and LDH elevation. The rRT-PCR test was positive for 2019-nCoV. He started treatment with hydroxychloroquine-ceftriaxone.
On hospital day five, the patient developed dysphonia, dysphagia, pleuritic pain, and subcutaneous emphysema in the supraclavicular region. His oxygen saturation was maintained at 97% with O2 at 3L / min through nasal cannula. A chest X-ray (Figure 1) and CT scan showed cervico-mediastinal emphysema (Figure 2) with pneumopericardium (Figure 3) and worsening lung infiltrates without pneumothorax.
Pneumopericardium is a rare condition, occasionally accompanied by pneumomediastinum, and is usually associated with positive pressure ventilation, thoracic surgery/pericardial fluid drainage, penetrating trauma, blunt trauma, infectious pericarditis with gas-producing organisms, and fistula between the pericardium and an adjacent air-containing organ (5).
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