key: cord-257867-3j6o1nko
authors: Romano, Nicola; Fischetti, Aldo; Melani, Enrico
title: Pneumomediastinum related to Covid-19 pneumonia
date: 2020-06-06
journal: Am J Med Sci
DOI: 10.1016/j.amjms.2020.06.003
sha: 
doc_id: 257867
cord_uid: 3j6o1nko

nan

most common radiological features of the Covid-19 pneumonia: multifocal bilateral peripheral ground glass areas and sub-segmental patchy consolidations with subpleural location and predominant involvement of lower lung lobes and posterior segments. In this context, among the different patterns and findings described, the presence of pneumomediastinum was rarely reported in literature [1, 2, 3] , and rarely considered in scientific debates. We herein report two cases of pneumomediastinum related to Covid-19 pneumonia, in patients who underwent chest-CT scan in our Hospital. The first patient was a 30-year-old male, who complained of fever (37.6°) and dyspnea with wheezing sounds at auscultation. Laboratory tests showed elevated leukocytes (13180 cells per μL) with 13,4% of lymphocytes; C-reactive protein was mildly elevated (3.26.mg/L). Unenhanced chest CT-scan revealed the presence of some small ground-glass opacities bilaterally, in particular in paracardiac regions of superior and inferior lobes, findings compatible with Covid-19 pneumonia.

Surprisingly, an amount of free air bubbles was present in the superficial cervical soft tissue (around sternocleidomastoid muscles and thyroid gland) and descending into the mediastinal cavity (around trachea, esophagus and great vessels) [ Figure 1A , known, a spontaneous pneumomediastinum may be caused by a pressure gradient between the alveoli and pulmonary interstitium leading to alveolar breakdown as described by Macklin. In cases of infection by SRAS-COV, pneumomediastinum may be related to damage and rupture of alveolar membrane caused by the virus [3, 5] . Although pneumomediastinum is usually considered a self-limiting condition, with an unknown precise pathological mechanism, we wanted to describe this possible complication of Covid-19 pneumonia, that may be considered

COVID-19 with spontaneous pneumomediastinum

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Spontaneous pneumomediastinum occurring in the SARS-COV-2 infection

Spontaneous pneumomediastinum: 41 cases

Molecular pathology of emerging coronavirus infections

Figure 1