Severe COVID-19 Pneumonia Complicated by Pneumothorax, Pneumomediastinum, and Pneumoperitoneum

• Published in: The American journal of tropical medicine and hygiene Vol. 104; no. 6; pp. 1951 - 1952
• Main Authors: Ahmed, Ashraf O E, Mohamed, Mouhand F H, Ahmed, Khalid
• Format: Journal Article
• Language: English
• Published: United States Institute of Tropical Medicine 05-04-2021; The American Society of Tropical Medicine and Hygiene
• Subjects: Coronaviruses; COVID-19; COVID-19 - complications; COVID-19 - pathology; COVID-19 - therapy; Emphysema; Humans; Images in Clinical Tropical Medicine; Male; Mediastinal Emphysema - etiology; Middle Aged; Pneumoperitoneum - etiology; Pneumothorax; Pneumothorax - etiology; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2
• ISSN: 0002-9637; 1476-1645
• DOI: 10.4269/ajtmh.21-0092

A 50-year-old man was presented with a 4-day history of fever and diarrhea. He experienced shortness of breath on the day of presentation. Physical examination indicated that the patient was in severe respiratory distress. His respiratory rate was 45 breaths/min, and his oxygen saturation was 93% with 15 L of oxygen/minute via a nonrebreathing mask. A chest examination showed diffuse crepitations. Nasopharyngeal swabbing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) yielded positive results. The C-reactive protein and ferritin levels were elevated. The chest X-ray (CXR) examination revealed bilateral lower zone infiltrates. Soon after admission, acute kidney injury developed and hemodialysis was started. Three days later, shortness of breath and desaturation developed; therefore, he was intubated and had a central line inserted (right jugular). The postprocedural CXR examination results were unremarkable. Coronavirus disease 2019 (COVID-19) has been reported to cause pneumothorax, which can worsen rapidly under the circumstances of mechanical ventilation because it can act as a shearing force that intensifies air leak into the mediastinum and even to the peritoneum.