COVID-19 Pneumonia Associated with Pneumomediastinum and Pneumothorax: Epidemiology and Evolution

Khemakhem, Rim; Wadhane, Issraa; Dhouib, Wided; Baffoun, Anis; Jmal, Mariam; Dammak, Maroua; Karoui, Abdelhamid; Kanoun, Imed; Kammoun, Samy

COVID-19 Pneumonia Associated with Pneumomediastinum and Pneumothorax: Epidemiology and Evolution

Document Type : Original Article

Authors

Rim khemakhem ¹

Issraa Wadhane ¹

Wided Dhouib ²

Anis Baffoun ²

Mariam Jmal ²

Maroua Dammak ²

Abdelhamid Karoui ²

Imed Kanoun ²

Samy Kammoun ¹^{, 2}

¹ Department of Pneumology, HEDI CHAKER Hospital, University of Sfax, Sfax, Tunisia

² Military Field Hospital, University of Sfax, Sfax, Tunisia

Abstract

Background: The occurrence of pneumomediastinum (PM) or pneumothorax (PTX) is a rare complication during COVID-19 pneumonia. The exact pathophysiological mechanisms remain unclear.
Materials and Methods: This retrospective study was carried out between March and July 2021, including hospitalized patients with COVID-19 who presented a PM or PTX during their evolution.
Results: Thirty-three patients were included in our study. The PM was spontaneous in 41.4% of cases (prevalence of 1.2%) and iatrogenic in 58.6% of cases (prevalence of 1.71%). Spontaneous isolated PTX was noted in 4 cases (12.1%). The management of pneumomediastinum was clinical and radiological monitoring in 30.3% of cases, and chest drainage in 21.2% (40% for spontaneous PTX, 83.3% for iatrogenic PTX, p=0.1). An association was found between mortality and the occurrence of PM (p=0.01), age (p=0,00), severity of radiological damage (p=0.03), severity of respiratory infection (p=0.01), the presence of signs of compression (p=0.03), and the use of mechanical ventilation (p=0.03).
Conclusion: COVID-19 patients with PM-PTX seem to have a higher mortality. Further research is needed to better identify risk factors and establish a consensus for managing it.

Keywords

Coronavirus

Pneumothorax

Severe acute respiratory syndrome

Treatment

Prognosis

Subjects