Surgical management of pneumomediastinum in the COVID-19 patient

BMJ Case Rep. 2022 Dec 22;15(12):e251744. doi: 10.1136/bcr-2022-251744.

Abstract

As the SARS-CoV-2 virus continues to infect millions of people worldwide, the medical profession is seeing a wide range of short-term and long-term complications of COVID-19. One lesser-known complication is that of pneumomediastinum. This is a rare, but significant, complication defined by the presence of air in the mediastinum with an incidence of 1.2 per 100 000. Described mortality rate is 30%, increasing to 60% in patients with concomitant pneumothoraces. Management of pneumomediastinum is typically conservative, but in cases of extensive subcutaneous emphysema, cardiac or airway compression, life-saving surgical decompression is necessary. We report a case of pneumomediastinum secondary to COVID-19, requiring a surgical approach not described in pneumomediastinum secondary to COVID-19. The case demonstrates the importance of prompt diagnosis and management, as well as the potential for good clinical outcome in selected patients.

Keywords: Adult intensive care; COVID-19; CPAP; Ear, nose and throat; Pneumomediastinum.

Publication types

  • Case Reports

MeSH terms

  • COVID-19* / complications
  • Humans
  • Mediastinal Emphysema* / diagnostic imaging
  • Mediastinal Emphysema* / etiology
  • Mediastinal Emphysema* / surgery
  • Pneumothorax* / complications
  • SARS-CoV-2
  • Tomography, X-Ray Computed / adverse effects