tetano
Editor, Senior Moderator
Clin Imaging
. 2020 Aug 26;67:207-213.
doi: 10.1016/j.clinimag.2020.08.013. Online ahead of print.
Spontaneous subcutaneous emphysema and pneumomediastinum in non-intubated patients with COVID-19
Sayan Manna[SUP] 1 [/SUP], Samuel Z Maron[SUP] 2 [/SUP], Mario A Cedillo[SUP] 2 [/SUP], Nicholas Voutsinas[SUP] 2 [/SUP], Danielle Toussie[SUP] 2 [/SUP], Mark Finkelstein[SUP] 2 [/SUP], Sharon Steinberger[SUP] 2 [/SUP], Michael Chung[SUP] 2 [/SUP], Adam Bernheim[SUP] 2 [/SUP], Corey Eber[SUP] 2 [/SUP], Yogesh Sean Gupta[SUP] 2 [/SUP], Jose Concepcion[SUP] 2 [/SUP], Richard Libes[SUP] 2 [/SUP], Adam Jacobi[SUP] 2 [/SUP]
Affiliations
Abstract
Purpose: We describe the presenting characteristics and hospital course of 11 novel coronavirus (COVID-19) patients who developed spontaneous subcutaneous emphysema (SE) with or without pneumomediastinum (SPM) in the absence of prior mechanical ventilation.
Materials and methods: A total of 11 non-intubated COVID-19 patients (8 male and 3 female, median age 61 years) developed SE and SPM between March 15 and April 30, 2020 at a multi-center urban health system in New York City. Demographics (age, gender, smoking status, comorbid conditions, and body-mass index), clinical variables (temperature, oxygen saturation, and symptoms), and laboratory values (white blood cell count, C-reactive protein, D-dimer, and peak interleukin-6) were collected. Chest radiography (CXR) and computed tomography (CT) were analyzed for SE, SPM, and pneumothorax by a board-certified cardiothoracic-fellowship trained radiologist.
Results: Eleven non-intubated patients developed SE, 36% (4/11) of whom had SE on their initial CXR. Concomitant SPM was apparent in 91% (10/11) of patients, and 45% (5/11) also developed pneumothorax. Patients developed SE on average 13.3 days (SD: 6.3) following symptom onset. No patients reported a history of smoking. The most common comorbidities included hypertension (6/11), diabetes mellitus (5/11), asthma (3/11), dyslipidemia (3/11), and renal disease (2/11). Four (36%) patients expired during hospitalization.
Conclusion: SE and SPM were observed in a cohort of 11 non-intubated COVID-19 patients without any known cause or history of invasive ventilation. Further investigation is required to elucidate the underlying mechanism in this patient population.
Keywords: COVID-19; Pneumomediastinum; Subcutaneous emphysema.
. 2020 Aug 26;67:207-213.
doi: 10.1016/j.clinimag.2020.08.013. Online ahead of print.
Spontaneous subcutaneous emphysema and pneumomediastinum in non-intubated patients with COVID-19
Sayan Manna[SUP] 1 [/SUP], Samuel Z Maron[SUP] 2 [/SUP], Mario A Cedillo[SUP] 2 [/SUP], Nicholas Voutsinas[SUP] 2 [/SUP], Danielle Toussie[SUP] 2 [/SUP], Mark Finkelstein[SUP] 2 [/SUP], Sharon Steinberger[SUP] 2 [/SUP], Michael Chung[SUP] 2 [/SUP], Adam Bernheim[SUP] 2 [/SUP], Corey Eber[SUP] 2 [/SUP], Yogesh Sean Gupta[SUP] 2 [/SUP], Jose Concepcion[SUP] 2 [/SUP], Richard Libes[SUP] 2 [/SUP], Adam Jacobi[SUP] 2 [/SUP]
Affiliations
- PMID: 32871424
- DOI: 10.1016/j.clinimag.2020.08.013
Abstract
Purpose: We describe the presenting characteristics and hospital course of 11 novel coronavirus (COVID-19) patients who developed spontaneous subcutaneous emphysema (SE) with or without pneumomediastinum (SPM) in the absence of prior mechanical ventilation.
Materials and methods: A total of 11 non-intubated COVID-19 patients (8 male and 3 female, median age 61 years) developed SE and SPM between March 15 and April 30, 2020 at a multi-center urban health system in New York City. Demographics (age, gender, smoking status, comorbid conditions, and body-mass index), clinical variables (temperature, oxygen saturation, and symptoms), and laboratory values (white blood cell count, C-reactive protein, D-dimer, and peak interleukin-6) were collected. Chest radiography (CXR) and computed tomography (CT) were analyzed for SE, SPM, and pneumothorax by a board-certified cardiothoracic-fellowship trained radiologist.
Results: Eleven non-intubated patients developed SE, 36% (4/11) of whom had SE on their initial CXR. Concomitant SPM was apparent in 91% (10/11) of patients, and 45% (5/11) also developed pneumothorax. Patients developed SE on average 13.3 days (SD: 6.3) following symptom onset. No patients reported a history of smoking. The most common comorbidities included hypertension (6/11), diabetes mellitus (5/11), asthma (3/11), dyslipidemia (3/11), and renal disease (2/11). Four (36%) patients expired during hospitalization.
Conclusion: SE and SPM were observed in a cohort of 11 non-intubated COVID-19 patients without any known cause or history of invasive ventilation. Further investigation is required to elucidate the underlying mechanism in this patient population.
Keywords: COVID-19; Pneumomediastinum; Subcutaneous emphysema.