key: cord-0796000-3ldoo5ly authors: Gillespie, Megan; Dincher, Nathan; Fazio, Pamela; Okorji, Onyinyechukwu; Finkle, Jacob; Can, Argun title: Coronavirus Disease 2019 (COVID-19) Complicated by Spontaneous Pneumomediastinum and Pneumothorax date: 2020-09-23 journal: Respir Med Case Rep DOI: 10.1016/j.rmcr.2020.101232 sha: cbd51306f617a52555b9699dd9fc0318e96b6c13 doc_id: 796000 cord_uid: 3ldoo5ly The first reports of severe acute respiratory symptoms from a novel coronavirus called coronavirus disease 2019 (COVID-19) occurred in Wuhan, Hubei Province, China in December 2019.(1) The World Health Organization declared COVID-19 a global pandemic by March 2020.(1) The COVID-19 outbreak has resulted in a current global health emergency. Clinical information about the findings of COVID-19 and its associated complications are constantly evolving and becoming more widely available. Providers should be familiar with both typical symptoms and image study results for COVID-19 as well as less commonly reported complications of progressive COVID-19, such as spontaneous pneumomediastinum and spontaneous pneumothorax as highlighted in this case. CT (computed tomography) CTA (computed tomography angiogram) COVID-19 (coronavirus disease 2019) CXR (Chest x-ray) SARS-CoV (severe acute respiratory syndrome coronavirus) SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) WHO (World Health Organization) The first reports of severe acute respiratory symptoms from a novel coronavirus called coronavirus disease 2019 (COVID-19) occurred in Wuhan, Hubei Province, China in December 2019. 1 The World Health Organization declared COVID-19 a global pandemic by March 2020. 1 The COVID-19 outbreak has resulted in a current global health emergency. Clinical information about the findings of COVID-19 and its associated complications are constantly evolving and becoming more widely available. Providers should be familiar with both typical symptoms and image study results for COVID-19 as well as less commonly reported complications of progressive COVID-19, such as spontaneous pneumomediastinum and spontaneous pneumothorax as highlighted in this case. The first reports of a novel coronavirus causing severe acute respiratory syndrome known as coronavirus 2 (SARS-CoV-2) occured in Wuhan, China in December 2019. 1 The World Health Organization (WHO) named the infections caused by this virus coronavirus disease 2019 (COVID-19). The WHO declared the current COVID-19 outbreak a global pandemic on March 11, 2020. 1 Symptoms of COVID-19 include fever, myalgias, fatigue, dry cough, nasal congestion, gastrointestinal symptoms such as diarrhea or nausea, sore throat, and change in sense of smell or taste. [2] [3] [4] [5] . Patients positive for COVID-19 frequently present with hypoxemia, The patient continued to decline clinically with increasing oxygen requirements despite initiation of hydroxychloroquine and high dose dexamethasone. On day seven of the patient's hospitalization, he was found to be more tachypneic and hypoxic requiring transition to supplemental oxygen of 50L/min by high-flow nasal cannula. Chest x-ray was repeated on this seventh day of his hospitalization, and spontaneous pneumomediastinum, subcutaneous emphysema, and bilateral patchy airspace disease were noted, all new findings compared to CXR on initial presentation (Figure 2 ). With these new findings on portable CXR, the patient had a computed tomography (CT) chest without IV contrast performed that also demonstrated extensive pneumomediastinum and bilateral groundglass opacities, but no pleural or pericardial effusion, no pneumothorax, and no lymphadenopathy (Figure 3 ). Several days later, the patient continued to have worsening respiratory status despite maximum supplemental oxygen therapy via high-flow nasal cannula and he was found to have a significantly elevated D-dimer prompting initiation of anticoagulation with heparin infusion and a CT angiogram (CTA) chest. CTA chest demonstrated extensive ground-glass opacities, pneumomediastinum, subcutaneous emphysema in the neck, and a new finding of a small right pneumothorax ( Figure 4A, 4B) . The patient eventually required endotracheal intubation for respiratory failure. Repeat imaging showed resolution of small right pneumothorax but continued pneumomediastinum. The patient's clinical status continued to deteriorate and after discussion with family the decision was made to palliatively extubate the patient. 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