Exuberant spontaneous pneumothorax pneumomediastinum pneumopericardium and subcutaneous emphysema in COVID-19 pneumonia

摘要

A 54-year-old man diagnosed with COVID-19 was admitted to the emergency department for increasing shortness of breath following a 2-week history of fever and fatigue. At admission, his chest X-ray showed bilateral patchy infiltrates, he was hypoxemic and noninvasive mechanical was initiated. On hospital day 4, subcutaneous emphysema was noticed and chest CT showed subcutaneous emphysema extending from the cervical region along the arms associated with pneumomediastinum, pneumopericardium and bilateral pneumothorax (figure 1). A chest drain was placed with pneumothorax resolution. However, respiratory failure further deteriorated and invasive mechanical ventilation was started on the next day. The patient was admitted to the intensive care unit (ICU). Due to prolonged ventilation and critical illness myopathy, a tracheostomy was performed after 22 days of invasive ventilation.