04 September 2021
: Case report 
Spontaneous Pneumomediastinum and Pneumothorax in Nonintubated COVID-19 Patients: A Multicenter Case Series
Rare coexistence of disease or pathology
Angela Iuorio1A, Francesca Nagar2E*, Laura Attianese2B, Anna Grasso
2F, Giacomo Torretta1B, Pierluigi Fusco1B, Maurizio Ferrara1A, Fausto Ferraro2E
DOI: 10.12659/AJCR.933405
Am J Case Rep 2021; 22:e933405
Table 1. Patient characteristics.
| Patient characteristics | Case 1 | Case 2 | Case 3 |
|---|---|---|---|
| Age, sex | 78 y, male | 70 y, male | 73 y, male |
| Comorbidities | Hypertension | Multiple myeloma | Pulmonary emphysema, arterial hypertension, hypercholesterolemia, previous ischemic stroke |
| Symptoms | Shortness of breath, fever, persistent cough | 3 d of cough, diarrhea, and fever | Shortness of breath, cough |
| Cardiac rate, beats/min | 109 | 112 | 100 |
| Blood pressure, mmHg | 100/60 | 109/70 | 136/90 |
| Temperature, °C | 38 | 36 | 35.5 |
| Saturation%, FiO 21% | 84 | 92 | 88 |
| pH | 7.42 | 7.48 | 7.49 |
| pO, mmHg | 68 | 67 | 60.7 |
| pCO, mmHg | 30 | 33 | 35 |
| Lactate, mmol/L | 1.5 | 1.4 | 2.3 |
| Respiratory support | O 15 L/min non-rebreathing mask | 4 L/min O nasal cannula | Venturi mask with FiO 0.5 |
| Computed tomography scan | Widespread bilateral ground-glass opacities, predominance in lower lobes | Diffuse bilateral ground-glass opacities | Pneumothorax with predominantly anterior basal distribution and more modest lateral parietal, in paramediastinal and subapical; predominantly peripheral localization, confluent fibrotic striae associated with traction emphysematous microbubbles. Interstitial engagement phenomena with thickening of the interlobar septa (crazy paving) affecting the upper lobes in the peribroncovascular |
| Therapy | Azithromycin, dexamethasone, low-molecular-weight heparin, and remdesivir | Azithromycin, dexamethasone, low-molecular-weight heparin, and remdesivir | Azithromycin, dexamethasone, low-molecular-weight heparin |
| Complications | Day 12 pneumomediastinum with a thin pneumothorax not drained | Day 6 pneumomediastinum | Pneumothorax at admission→ inserted drainage tube |
| Follow-up | Transferred to Intensive Care Unit, died after 15 d | Discharged home after 32 d of hospitalization | Discharged home after 31 d of hospitalization |