key: cord-1002914-c05skuwz
authors: Lei, Pinggui; Mao, Jujiang; Wang, Pingxian
title: Spontaneous Pneumomediastinum in a Patient with Coronavirus Disease 2019 Pneumonia and the Possible Underlying Mechanism
date: 2020-05-06
journal: Korean J Radiol
DOI: 10.3348/kjr.2020.0426
sha: c693d60a91df6d879cb75ea9d6b224081b6fef16
doc_id: 1002914
cord_uid: c05skuwz

nan

that cause SARS and Middle East respiratory syndrome might have similar characteristics as they belong to the same family Coronaviridae. Spontaneous pneumomediastinum was reported in patients with SARS in 2003 (2) . A study showed that a substantial proportion (12%) of patients with SARS could develop spontaneous pneumomediastinum unrelated to the use of positive end-expiratory pressure ventilation (2) . In SARS, spontaneous pneumomediastinum occurs most frequently when the ground-glass opacities (GGOs) and consolidations in the lungs begin to resolve (3) . In this situation, peribronchiolar abscess formation probably leads to interstitial pulmonary emphysema, which tracks back along the bronchovascular sheath and reaches the mediastinum (3). Subsequently, chest CT shows spontaneous pneumomediastinum (3) . We believe that the mechanism underlying pneumomediastinum in patients with COVID-19 pneumonia is similar to that in patients with SARS because the viruses in the same Coronaviridae family may have similar pathogeneses and imaging features. At our hospital, one (7.14%) out of 14 patients with COVID-19 pneumonia developed spontaneous pneumomediastinum. The patient was a 64-year-old man complaining of fever and fatigue for 7 days. He had a history of recent travel to an area with the COVID-19 epidemic. Chest CT performed 17 days after the onset of symptoms showed progressive resolution of the patient's pneumonic lesions and the presence of spontaneous pneumomediastinum in the anterior mediastinum (Fig. 1A) , which had been absent on CT performed at the time of the initial diagnosis (not presented). Follow-up CT performed 24 days after the onset of symptoms revealed resolution of the previously seen anterior pneumomediastinum (Fig. 1B) .

Some typical CT features are observed in the patients with COVID-19 pneumonia. GGOs and consolidation are distributed in the peripheral bronchovascular or subpleural areas in the lower lobes, particularly in the right lower lobe, in the early stage. In the advanced or severe stages, GGOs decrease, and GGOs mixed with consolidation or consolidation increase. Fibrosis can be detected as lung lesions dissipate. This case as well as the previously reported cases might indicate that spontaneous pneumomediastinum on CT may be discovered in the late stages when GGOs and GGOs mixed with consolidations begin to resolve.

Mediastinal emphysema, giant bulla, and pneumothorax developed during the course of COVID-19 pneumonia

Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study

Severe acute respiratory syndrome: spectrum of highresolution CT findings and temporal progression of the disease