04 September 2021>: Articles
Spontaneous Pneumomediastinum and Pneumothorax in Nonintubated COVID-19 Patients: A Multicenter Case Series
Rare coexistence of disease or pathology
Angela Iuorio A , Francesca Nagar E* , Laura Attianese B , Anna Grasso F , Giacomo Torretta B , Pierluigi Fusco B , Maurizio Ferrara A , Fausto Ferraro EDOI: 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 |