Xiang Chunlin, Wu Gang
Department of Radiology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China.
Medicine (Baltimore). 2020 May;99(20):e20208. doi: 10.1097/MD.0000000000020208.
Since the end of 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has affected more than 1,000,000 population in the world. Subcutaneous emphysema and pneumothorax are uncommon complications of SARS-CoV-2 pneumonia. Herein, we describe a fatal case of SARS-CoV-2 pneumonia with subcutaneous emphysema and pneumothorax.
Subcutaneous emphysema was found in neck, bilateral chest walls, abdomen wall, groin area, and scrotum of a 67-year-old man. Extensive air-space opacities, subcutaneous emphysema and a small amount of pneumothorax were found in his chest X-ray scan. Echocardiography showed left ventricular enlargement with ejection fraction 20%.
This resident of Wuhan with laboratory-confirmed SARS-CoV-2 infection had chronic pulmonary and cardiac diseases. Liver dysfunction, myocardial injury, and coagulation disorder were suggested by laboratory findings. Pneumonia, subcutaneous emphysema, and pneumothorax were confirmed with chest X-ray. Heart failure was revealed by echocardiography.
He was transferred to intensive care unit, where invasive ventilation was used for him during the whole hospitalization. Prone position ventilation, vasoconstrictor, antibacteria, and antiviral therapy were given.
He died on the twelfth day after admission.
Subcutaneous emphysema and pneumothorax may occur in patients with SARS-CoV-2 pneumonia and chronic pulmonary disease. Chronic cardiac disease might be aggravated by SARS-CoV-2 infection, and develop heart failure.
自2019年底以来，严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染已影响全球超过100万人。皮下气肿和气胸是SARS-CoV-2肺炎罕见的并发症。在此，我们描述一例伴有皮下气肿和气胸的SARS-CoV-2肺炎致死病例。
一名67岁男性的颈部、双侧胸壁、腹壁、腹股沟区和阴囊发现皮下气肿。胸部X线扫描发现广泛的气腔混浊、皮下气肿和少量气胸。超声心动图显示左心室扩大，射血分数为20%。
这名来自武汉的居民经实验室确诊感染SARS-CoV-2，患有慢性肺部和心脏疾病。实验室检查结果提示肝功能障碍、心肌损伤和凝血障碍。胸部X线证实为肺炎、皮下气肿和气胸。超声心动图显示心力衰竭。
他被转入重症监护病房，住院期间全程接受有创通气治疗。给予俯卧位通气、血管收缩剂、抗菌和抗病毒治疗。
他在入院后第12天死亡。
SARS-CoV-2肺炎合并慢性肺部疾病患者可能发生皮下气肿和气胸。SARS-CoV-2感染可能会加重慢性心脏病，并导致心力衰竭。
