ORIGINAL ARTICLE   

Minerva Medica 2021 December;112(6):779-85

DOI: 10.23736/S0026-4806.21.07585-6

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Pneumomediastinum associated with severe pneumonia related to COVID-19: diagnosis and management

Corinna GANDOLFO ¹, Monica BONFIGLIO ¹, Giulia SPINETTO ¹, Gianluca FERRAIOLI ², Cornelius BARLASCINI ³, Antonello NICOLINI ⁴ ✉, Paolo SOLIDORO ^{5, 6}

¹ COVID-19 Intensive Care Unit, General Hospital of Sestri Levante, Sestri Levante, Genoa, Italy; ² COVID-19 Unit, General Hospital of Sestri Levante, Sestri Levante, Genoa, Italy; ³ Unit of Hygiene and Health Medicine, General Hospital of Sestri Levante, Sestri Levante, Genoa, Italy; ⁴ Unit of Respiratory Diseases, General Hospital of Sestri Levante, Sestri Levante, Genoa, Italy; ⁵ Department of Medical Sciences, University of Turin, Turin, Italy; ⁶ Division of Respiratory Diseases, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy

BACKGROUND: Pneumomediastinum (PNM) can develop as a severe complication of severe COVID-19 and may be correlated with greater morbidity and mortality. PNM is a rarely reported complication in COVID-19 patients and usually associated with endotracheal intubation.
METHODS: Our aim was to describe the characteristics of patients with PNM in twenty-one patients with COVID-19 related pneumonia and acute respiratory failure in a retrospective case series.
RESULTS: Twenty-one patients were diagnosed, four were treated with high-flow nasal cannula, thirteen with non invasive ventilation and four with invasive mechanical ventilation. In five cases PNM was massive and associated to subcutaneous emphysema; more rarely PNM was associated with pneumothorax. Conservative management was the most used therapeutic strategy.
CONCLUSIONS: PNM is a serious and not extremely rare complication of severe forms of pulmonary involvement of COVID-19. The clinician should consider this rare complication; moreover, we suggest being careful when clinicians start mechanical ventilation.

KEY WORDS: COVID-19; Pneumonia; Pneumomediastinum, diagnostic