Pneumothorax, Pneumomediastinum and Subcutaneous Emphysema in Patients with COVID-19 Pneumonia: Evaluation of 26 Cases

Abstract

Objective: The study aims to contribute to the literature by sharing the treatment process and results of patients who develop pneumothorax, pneumomediastinum, and subcutaneous emphysema, which are rarely seen in COVID-19 pneumonia, and to reveal the possible high mortality situation.Methods: Patients whose COVID-19 polymerase chain reaction (PCR) swab test was positive and were diagnosed as COVID-19 pneumonia by thoracic computed tomography (CT) and who developed pneumothorax, pneumomedias-tinum, and subcutaneous emphysema while under home treatment or inpatient treatment in the 14 months between April 2020 and June 2021and were followed in the pandemic emergency department were retrospectively included in the study. The cases were evaluated in terms of age, gender, occurrence, and timing of these pathologies during home or hospital treatment, hospitalization time, mortality, smoking, and comorbidities.Results: Twenty-six patients (4 women and 22 men, mean age 52 years) with COVID-19 pneumonia were included in the study. Fifteen patients (57.7%) were being treated at home while developing pneumothorax, pneumomediastinum, and subcutaneous emphysema pathologies. The mean age of female patients was 74 years; 3 had pneumomediastinum, and one had combined pneumothorax and pneumomediastinum. All of them were followed in the intensive care unit (ICU). Two patients were intubated, and the other two received treatment on a high-flow oxygen device. Three of them died. The mean age of male patients was 48.2. Twelve had pneumothorax, 8 had pneumomediastinum, and two had combined pneumothorax and pneumomediastinum. Fifteen patients were diagnosed while being followed at home, and 7 patients were diagnosed during ICU treatment. Five of the patients died, and all of them were ICU patients. Eight patients (30.8%) died in total. The mean age of these patients was 76.4 (min:63, max:82). The patients had additional diseases such as hypertension, diabetes mellitus, organ transplantation, heart, and kidney failure. Age, comorbidity, and being treated in the ICU were found to be statistically significant (p<0.005).Conclusion: The possible high mortality risk in these clinical situations, which can be seen in the ongoing COVID-19 pandemic, should be considered.