Spontaneous Pneumomediastinum, Mediastinitis and Subcutaneous Emphysema Occurring in the Post Sars-Cov-2 Infection: An Uncommon Presentation
Spontaneous Pneumomediastinum in Post Sarscov-2
Background: Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), declared as a pandemic by World Health Organization. Computed Tomography provides an imaging perspective towards many parenchymal and rare extra-parenchymal abnormalities of the COVID-19 pneumonia like spontaneous pneumothorax, pneumomediastinum and subcutaneous emphy- sema helping further in diagnosis and surveillance. Case Report: A 53-year-old male was admitted with RT-PCR positive report of COVID19 pneumonia presented with hypoxemia and was started on non-invasive ventilation with lung protective ventilation and other symptomatic management. He developed sudden onset shortness of breath and chest pain on Day 14 of admission with a SpO2 of 90 % on NIV ventilation, after testing negative on RT-PCR on day 12. A HRCT (high resolution CT) chest was obtained that showed extensive consolidations ground glass opacities and “crazy paving appearance” in bilateral lung fields. A calcified nodule with positive “halo sign” was seen. Presence of air was seen along the perivascular sheath, peribronchial sheaths (“Double bronchial wall sign” positive) and into the subcutaneous neck space on both sides and anterior chest wall, which was suggestive of pneumomediastinum with subcutaneous emphysema. Contrast enhanced computed tomography images showed multiple thin septations showing minimal enhancement surrounding the mediastinal fat that was suggestive of mediastinitis. He was managed conservatively and gradually improved. Conclusion: Spontaneous pneumomediastinum and subcutaneous emphysema are quite a rare complication in the immediate post COVID19 pneumonia period and can result in remarkable morbidity for the patient. Keeping a high index of suspicion and early identification of the same is possible using CT Chest which aides in identification and management of such patients.
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