RESUMO
BACKGROUND: With the prevalence of coronavirus disease 2019 (COVID-19), many severe cases have been discovered worldwide. Here, a case of concurrent pneumomediastinum, pneumoretroperitoneum, and intestinal perforation was reported. This case was the first report on COVID-19-induced related complications. CASE PRESENTATION: A 74-year-old female patient was hospitalized for COVID-19. Air leakage was unexpectedly found during imaging reexamination. Considering the unobvious subjective feeling of the patient, a conservative treatment was given at the early stage, and finally, sigmoid colon perforation was surgically confirmed. The family gave up the treatment at last, because the patient could not be taken off the ventilator. Coincidentally, the patient also had abnormal renal anatomical position. This situation led to an abnormal air leakage direction and the atypical manifestations of peritonitis. It was also one of the important reasons for the delayed diagnosis and treatment of the disease. CONCLUSIONS: Clinicians should be vigilant for spontaneous gastrointestinal perforation in patients with COVID-19, particularly those undergoing treatment with glucocorticoids and tocilizumab. The case is shared to highlight this rare and fatal extrapulmonary manifestation of COVID-19 and further assist clinicians to raise their awareness and timely implement imaging investigation and multidisciplinary intervention so as to facilitate early discovery, diagnosis and treatment and reduce the mortality.
Assuntos
COVID-19 , Perfuração Intestinal , Enfisema Mediastínico , Retropneumoperitônio , SARS-CoV-2 , Humanos , COVID-19/complicações , Feminino , Idoso , Perfuração Intestinal/virologia , Perfuração Intestinal/etiologia , Enfisema Mediastínico/etiologia , Enfisema Mediastínico/diagnóstico por imagem , Enfisema Mediastínico/virologia , Retropneumoperitônio/etiologia , Retropneumoperitônio/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND COVID-19 caused by SARS-CoV-2 has become a global pandemic. Diagnosis is based on clinical features, nasopharyngeal swab analyzed with real-time reverse transcription-polymerase chain reaction, and computer tomography (CT) scan pathognomonic signs. The most common symptoms associated with COVID-19 include fever, coughing, and dyspnea. The main complications are acute respiratory distress syndrome, pneumonia, kidney failure, bacterial superinfections, coagulation abnormalities with thromboembolic events, sepsis, and even death. The common CT manifestations of COVID-19 are ground-glass opacities with reticular opacities and consolidations. Bilateral lung involvement can be present, especially in the posterior parts and peripheral areas. Pleural effusion, pericardial effusion, and lymphadenopathy are rarely described. Spontaneous pneumothorax and pneumomediastinum have been observed as complications in patients with SARS-CoV-2 pneumonia during mechanical ventilation or noninvasive positive pressure ventilation, as well as in patients with spontaneous breathing receiving only oxygen therapy via nasal cannula or masks. CASE REPORT We present 2 cases of pneumomediastinum with and without pneumothorax in patients with active SARS-Cov-2 infection and 1 case of spontaneous pneumothorax in a patient with a history of paucisymptomatic SARS-CoV-2 infection. In these 3 male patients, ages 78, 73, and 70 years, respectively, COVID-19 was diagnosed through nasopharyngeal sampling tests and the presence of acute respiratory distress syndrome. CONCLUSIONS Both pneumothorax and pneumomediastinum, although rare, may be complications during or after SARS-CoV-2 infection even in patients who are spontaneously breathing. The aim of this study was to describe an increasingly frequent event whose early recognition can modify the prognosis of patients.
Assuntos
COVID-19 , Enfisema Mediastínico , Pneumotórax , Idoso , COVID-19/complicações , Humanos , Masculino , Enfisema Mediastínico/diagnóstico por imagem , Enfisema Mediastínico/virologia , Pandemias , Pneumotórax/diagnóstico por imagem , Pneumotórax/virologiaRESUMO
The presenting symptoms and features of COVID-19 are non-specific and may be extrapulmonary complications such as thrombotic disorders but also pneumothorax, pneumomediastinum and subcutaneous emphysema; which are well-known complications of mechanical ventilation. Nevertheless, pneumothorax and/or pneumomediastinum, could complicate the course of a COVID-19 disease even in the absence of barotrauma involved. Herein, we report the case of a 55-year-old man with a previous history of erythroblastopenia due to thymoma admitted for COVID-19-related acute respiratory distress syndrome (ARDS) who simultaneously developed spontaneous tension pneumothorax, pneumomediastinum, subcutaneous emphysema and acute bilateral pulmonary embolism as presenting features of COVID-19 while on high-flow nasal cannula. This rare case highlights the importance of screening for other coexisting alternative diagnoses at the initial presentation of a patient suspected of COVID-19.
Assuntos
COVID-19/diagnóstico , Síndrome do Desconforto Respiratório/virologia , Doença Aguda , COVID-19/complicações , Hospitalização , Humanos , Masculino , Enfisema Mediastínico/virologia , Pessoa de Meia-Idade , Pneumotórax/virologia , Embolia Pulmonar/virologia , Enfisema Subcutâneo/virologiaRESUMO
Spontaneous pneumomediastinum is reported in patients with coronavirus disease-2019 (COVID-19) and influenza infection independently, usually associated with noninvasive and mechanical ventilation. We report a case of spontaneous pneumomediastinum in a patient with COVID-19 and influenza coinfection. A 58-year-old male admitted with shortness of breath, diagnosed with COVID-19 and influenza infection. A computed tomography angiogram showed pneumomediastinum. He was treated conservatively with 15 L of oxygen, remdesivir, convalescent plasma, and oseltamivir. The case is being reported for its uniqueness since this is the first documented case of spontaneous pneumomediastinum in COVID-19 and influenza coinfection.
Assuntos
COVID-19/complicações , Influenza Humana/complicações , Enfisema Mediastínico/virologia , Pneumonia Viral/complicações , Antivirais/uso terapêutico , COVID-19/diagnóstico , COVID-19/terapia , Coinfecção , Terapia Combinada , Quimioterapia Combinada , Humanos , Imunização Passiva , Influenza Humana/diagnóstico , Influenza Humana/terapia , Masculino , Enfisema Mediastínico/diagnóstico por imagem , Enfisema Mediastínico/terapia , Pessoa de Meia-Idade , Oxigenoterapia , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , SARS-CoV-2 , Soroterapia para COVID-19RESUMO
The development of spontaneous pneumomediastinum and subcutaneous emphysema are few of the rare clinical manifestations observed in coronavirus disease-19 (COVID-19) patients which are yet to be fully understood. Most cases of spontaneous pneumomediastinum arise due to factors causing high intra-alveolar pressure. Herein, we report a case of a COVID-19 positive elderly male, who presented with spontaneous pneumomediastinum and subcutaneous emphysema unrelated to high-pressure ventilatory measures, detected on chest computed tomography (CT). Despite acute medical care, the patient progressed towards a more serious clinical course. Male gender and diffuse alveolar damage caused by COVID-19 seems to be the most relevant association in this case. However, we have enlightened other possible pathological mechanisms and their association with severity index of COVID-19.
Assuntos
COVID-19/complicações , Enfisema Mediastínico/diagnóstico por imagem , Enfisema Subcutâneo/diagnóstico por imagem , COVID-19/fisiopatologia , Progressão da Doença , Humanos , Masculino , Enfisema Mediastínico/virologia , Pessoa de Meia-Idade , Enfisema Subcutâneo/virologia , Tomografia Computadorizada por Raios XRESUMO
Real-Time-reverse-transcription-Polymerase-Chain-Reaction from nasopharyngeal swabs and chest computed tomography (CT) depicting typically bilateral ground-glass opacities with a peripheral and/or posterior distribution are mandatory in the diagnosis of COVID-19. COVID-19 pneumonia may present though with atypical features such as pleural and pericardial effusions, lymphadenopathy, cavitations, and CT halo sign. In these two case-reports, COVID-19 presented as pneumothorax, pneumomediastinum and subcutaneous emphysema in critically ill patients. These disorders may require treatment or can be even self-limiting. Clinicians should be aware of their potential effects on the cardiorespiratory status of critically ill COVID-19 patients. Finally, pneumothorax can be promptly diagnosed by means of lung ultrasound. Although operator dependent, lung ultrasound is a useful bedside diagnostic tool that could alleviate the risk of cross-infection related to COVID-19 patient transport.
Assuntos
COVID-19/complicações , Enfisema Mediastínico , Pneumotórax , Enfisema Subcutâneo , Humanos , Unidades de Terapia Intensiva , Masculino , Enfisema Mediastínico/diagnóstico por imagem , Enfisema Mediastínico/virologia , Pessoa de Meia-Idade , Pneumotórax/diagnóstico por imagem , Pneumotórax/virologia , Enfisema Subcutâneo/diagnóstico por imagem , Enfisema Subcutâneo/virologiaAssuntos
COVID-19/diagnóstico por imagem , Enfisema Mediastínico/virologia , Síndrome do Desconforto Respiratório/virologia , Adulto , COVID-19/complicações , Evolução Fatal , Humanos , Masculino , Enfisema Mediastínico/diagnóstico por imagem , Pessoa de Meia-Idade , Radiografia , Síndrome do Desconforto Respiratório/diagnóstico por imagemRESUMO
Spontaneous pneumomediastinum (SPM) and pneumothorax (PNX) unrelated to positive pressure ventilation has been recently reported as an unusual complication in cases of severe COVID-19 pneumonia. The presumed pathophysiological mechanism is diffuse alveolar injury leading to alveolar rupture and air leak. We present a case of COVID-19 pneumonia complicated on day 13 post admission by SPM, PNX and subcutaneous emphysema in a patient with no identifiable risk factors for such complication. The patient received medical treatment for his COVID-19 infection without the use of an invasive or non-invasive ventilator. Moreover, he is a non-smoker with no lung comorbidities and never reported a cough. He was eventually discharged home in stable condition. A comprehensive literature review revealed 15 cases of SPM developing in patients with COVID-19 pneumonia.
Assuntos
COVID-19/complicações , Enfisema Mediastínico/virologia , Pneumotórax/virologia , Enfisema Subcutâneo/virologia , COVID-19/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , SARS-CoV-2RESUMO
INTRODUCTION: Pneumothorax and pneumomediastinum have both been noted to complicate cases of coronavirus disease 2019 (COVID-19) requiring hospital admission. We report the largest case series yet described of patients with both these pathologies (including nonventilated patients). METHODS: Cases were collected retrospectively from UK hospitals with inclusion criteria limited to a diagnosis of COVID-19 and the presence of either pneumothorax or pneumomediastinum. Patients included in the study presented between March and June 2020. Details obtained from the medical record included demographics, radiology, laboratory investigations, clinical management and survival. RESULTS: 71 patients from 16 centres were included in the study, of whom 60 had pneumothoraces (six with pneumomediastinum in addition) and 11 had pneumomediastinum alone. Two of these patients had two distinct episodes of pneumothorax, occurring bilaterally in sequential fashion, bringing the total number of pneumothoraces included to 62. Clinical scenarios included patients who had presented to hospital with pneumothorax, patients who had developed pneumothorax or pneumomediastinum during their inpatient admission with COVID-19 and patients who developed their complication while intubated and ventilated, either with or without concurrent extracorporeal membrane oxygenation. Survival at 28â days was not significantly different following pneumothorax (63.1±6.5%) or isolated pneumomediastinum (53.0±18.7%; p=0.854). The incidence of pneumothorax was higher in males. 28-day survival was not different between the sexes (males 62.5±7.7% versus females 68.4±10.7%; p=0.619). Patients aged ≥70 years had a significantly lower 28-day survival than younger individuals (≥70â years 41.7±13.5% survival versus <70â years 70.9±6.8% survival; p=0.018 log-rank). CONCLUSION: These cases suggest that pneumothorax is a complication of COVID-19. Pneumothorax does not seem to be an independent marker of poor prognosis and we encourage continuation of active treatment where clinically possible.
Assuntos
COVID-19/complicações , Enfisema Mediastínico/epidemiologia , Enfisema Mediastínico/virologia , Pneumotórax/epidemiologia , Pneumotórax/virologia , SARS-CoV-2 , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , COVID-19/mortalidade , COVID-19/terapia , Oxigenação por Membrana Extracorpórea , Feminino , Hospitalização , Humanos , Incidência , Masculino , Enfisema Mediastínico/terapia , Pessoa de Meia-Idade , Pneumotórax/terapia , Prognóstico , Respiração Artificial , Estudos Retrospectivos , Fatores Sexuais , Taxa de Sobrevida , Reino Unido , Adulto JovemRESUMO
Coronavirus disease 2019 (COVID-19) has posed an unparalleled challenge to the medical communities and patients worldwide. This is the third coronavirus pandemic of the decade and worst so far in terms of the number of patients affected and related deaths. Although COVID-19 is a systemic illness, the respiratory system is obvious to be involved first, and takes most of the brunt of SARS-CoV-2 infection. Common upper and lower respiratory presentations could be sore throat, consolidation, ground glass opacities, and acute respiratory distress syndrome in severe cases. Pneumothorax, pneumomediastinum are uncommon clinical findings in association with COVID-19. We hereby report a rare case of spontaneous pneumomediastinum with a synchronous pneumopericardium.
Assuntos
Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Pneumopericárdio/virologia , Betacoronavirus , COVID-19 , Humanos , Masculino , Enfisema Mediastínico/virologia , Pessoa de Meia-Idade , Pandemias , SARS-CoV-2RESUMO
Spontaneous pneumomediastinum (SPM) and Loculated pneumothorax (LPNX) are both generally rare clinical and radiological conditions associated with Coronavirus Disease 2019 (COVID-19). We report for the first time clinical data and radiological chest CT imaging of two patients affected by COVID-pneumonia associated with early radiological findings of SPM and LPNX.
Assuntos
Infecções por Coronavirus , Enfisema Mediastínico , Pandemias , Pneumonia Viral , Pneumotórax , Adulto , Idoso , Betacoronavirus , COVID-19 , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/patologia , Feminino , Humanos , Masculino , Enfisema Mediastínico/diagnóstico por imagem , Enfisema Mediastínico/patologia , Enfisema Mediastínico/virologia , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/patologia , Pneumotórax/diagnóstico por imagem , Pneumotórax/patologia , Pneumotórax/virologia , SARS-CoV-2 , Tomografia Computadorizada por Raios XRESUMO
A case is presented highlighting the emerging association of COVID-19 with pneumomediastinum, even in patients who have never received mechanical ventilation or positive airway pressure.
Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Enfisema Mediastínico/diagnóstico por imagem , Enfisema Mediastínico/virologia , Pneumonia Viral/complicações , COVID-19 , Angiografia por Tomografia Computadorizada , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , SARS-CoV-2RESUMO
The new disease outbreak that causes atypical pneumonia named COVID-19, which started in China's Wuhan province, has quickly spread to a pandemic. Although the imaging test of choice for the initial study is plain chest radiograph, CT has proven useful in characterizing better the complications associated with this new infection. We describe the evolution of 3 patients presenting pneumomediastinum and spontaneous pneumothorax as a very rare complication of COVID-19 and their particular interest as a probable prognostic factor.
Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico por imagem , Enfisema Mediastínico/diagnóstico por imagem , Enfisema Mediastínico/virologia , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico por imagem , Pneumotórax/diagnóstico por imagem , Pneumotórax/virologia , Tomografia Computadorizada por Raios X/métodos , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , COVID-19 , Meios de Contraste , Evolução Fatal , Feminino , Humanos , Masculino , Pandemias , Radiografia Torácica , SARS-CoV-2Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico por imagem , Enfisema Mediastínico/diagnóstico por imagem , Enfisema Mediastínico/virologia , Pneumonia Viral/diagnóstico por imagem , Adulto , COVID-19 , Infecções por Coronavirus/patologia , Humanos , Masculino , Enfisema Mediastínico/patologia , Pandemias , Pneumonia Viral/patologia , SARS-CoV-2 , Tomografia Computadorizada por Raios XAssuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Enfisema Mediastínico/diagnóstico por imagem , Enfisema Mediastínico/virologia , Pneumonia Viral/complicações , Enfisema Subcutâneo/diagnóstico por imagem , Enfisema Subcutâneo/virologia , COVID-19 , Serviço Hospitalar de Emergência , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pandemias , Radiografia , SARS-CoV-2 , Tomografia Computadorizada por Raios XAssuntos
Infecções por Coronavirus/complicações , Enfisema Mediastínico/virologia , Pneumonia Viral/complicações , Pneumotórax/virologia , Enfisema Subcutâneo/virologia , Betacoronavirus , COVID-19 , Infecções por Coronavirus/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/fisiopatologia , SARS-CoV-2 , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND Pneumonia is one of the most common causes of death from infectious disease in the United States (US). Although most cases of community-acquired pneumonia (CAP) are secondary to bacterial infection, up to one-third of cases are secondary to viral infection, most commonly due to rhinovirus and influenza virus. Pneumonia due to herpes simplex virus (HSV) is rare, and there is limited knowledge of the pathogenesis and clinical complications. This report is of a fatal case of HSV pneumonia associated with bilateral pneumothorax and pneumomediastinum. CASE REPORT A 36-year-old homeless male Hispanic patient, who was a chronic smoker, with a history of intravenous drug abuse and a medical history of chronic hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infection, not on highly active antiretroviral therapy (HAART), was admitted to hospital as an emergency with a seven-day history of productive purulent cough. The patient was admitted to the medical intensive care unit (MICU) with a diagnosis of CAP, with intubation and mechanical ventilation. Broncho-alveolar lavage (BAL) was performed and was positive for HSV. The patient developed bilateral pneumothorax with pneumomediastinum, which was fatal, despite aggressive clinical management. CONCLUSIONS Pneumonia due to HSV infection is uncommon but has a high mortality. Although HSV pneumonia has been described in immunocompromised patients, further studies are required to determine the pathogenesis, early detection, identification of patients who are at risk and to determine the most effective approaches to prophylaxis and treatment for HSV pneumonia.
Assuntos
Herpes Simples/complicações , Herpes Simples/diagnóstico , Enfisema Mediastínico/virologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , Pneumotórax/virologia , Adulto , Evolução Fatal , Humanos , Masculino , Enfisema Mediastínico/diagnóstico , Pneumotórax/diagnóstico , SimplexvirusAssuntos
Influenza Humana/complicações , Enfisema Mediastínico/complicações , Enfisema Subcutâneo/complicações , Antivirais/uso terapêutico , Humanos , Vírus da Influenza A Subtipo H1N1/efeitos dos fármacos , Vírus da Influenza A Subtipo H1N1/genética , Vírus da Influenza A Subtipo H1N1/patogenicidade , Influenza Humana/diagnóstico por imagem , Influenza Humana/tratamento farmacológico , Influenza Humana/virologia , Masculino , Enfisema Mediastínico/diagnóstico por imagem , Enfisema Mediastínico/tratamento farmacológico , Enfisema Mediastínico/virologia , Pessoa de Meia-Idade , Oseltamivir/uso terapêutico , Oxigênio/uso terapêutico , Enfisema Subcutâneo/diagnóstico por imagem , Enfisema Subcutâneo/tratamento farmacológico , Enfisema Subcutâneo/virologia , Tomografia Computadorizada por Raios XRESUMO
Human bocavirus (HBoV), that was first identified in 2005 and classified in Parvoviridae family, is a small, non-enveloped, single-stranded DNA virus, responsible for upper and lower respiratory tract infections, especially in young children. Although HBoV generally causes self-limited influenza-like illness, it may also lead to pneumonia, bronchiolitis, croup and asthma attacks. In this report, a case of acute bronchiolitis complicated with pneumomediastinum and bilateral pneumothorax caused by HBoV has been presented. A three-year-old boy was referred to our pediatric intensive care unit with a two day history of fever, tachypnea, hypoxia and respiratory failure. On auscultation, there were widespread expiratory wheezing and inspiratory crackles. The chest radiography yielded paracardiac infiltration and air trapping on the right lung and infiltration on the left lung. The patient had leukocytosis and elevated C-reactive protein level. On the second day of admission, respiratory distress worsened and chest radiography revealed right pneumothorax and subcutaneous emphysema in bilateral cervical region and left chest wall. He was intubated because of respiratory failure. In the thorax computed tomography, pneumomediastinum and bilateral pneumothorax were detected and right chest tube was inserted. Repetitive blood and tracheal aspirate cultures were negative. A nasopharyngeal swab sample was analyzed by multiplex real-time polymerase chain reaction method with the use of viral respiratory panel (FTD(®) Respiratory Pathogens 21 Kit, Fast-Track Diagnostics), and positive result was detected for only HBoV. On the ninth day of admission, pneumomediastinum and bilateral pneumothorax improved completely and he was discharged with cure. In conclusion, HBoV bronchiolitis may progress rare but severe complications, it should be kept in mind as an etiological agent of the respiratory tract infections especially children younger than five years old.
Assuntos
Bronquiolite/virologia , Bocavirus Humano/patogenicidade , Enfisema Mediastínico/virologia , Infecções por Parvoviridae/virologia , Pneumotórax/virologia , Bronquiolite/complicações , Pré-Escolar , Bocavirus Humano/genética , Bocavirus Humano/isolamento & purificação , Humanos , Intubação Intratraqueal , Masculino , Enfisema Mediastínico/diagnóstico por imagem , Reação em Cadeia da Polimerase Multiplex , Nasofaringe/virologia , Infecções por Parvoviridae/complicações , Pneumotórax/diagnóstico por imagem , Reação em Cadeia da Polimerase em Tempo Real , Insuficiência Respiratória/terapia , Insuficiência Respiratória/virologia , Tomografia Computadorizada por Raios XRESUMO
The occurrence of spontaneous pneumomediastinum in swine flu, or H1N1 influenza A infection, is a rare phenomenon and only few cases have been reported in children. We describe a case of spontaneous pneumomediastinum in adult infected with swine flu.