Department of Internal Medicine, University of Texas Health- McGovern Medical School, TX, United States.
Divisions of Critical Care, Pulmonary and Sleep Medicine, University of Texas Health- McGovern Medical School, TX, United States.
Am J Med Sci. 2022 Jun;363(6):548-551. doi: 10.1016/j.amjms.2020.11.024. Epub 2020 Nov 26.
COVID- 19 has become a major pandemic affecting more than 11 million people worldwide. Common radiological manifestations of COVID-19 include peripheral based ground-glass or consolidative opacities; however, pneumothorax and pneumo-mediastinum are very rare manifestations; even more so within patients not on mechanical ventilation. We present a case series of 5 patients with COVID-19 who either presented with or developed spontaneous pneumothorax or pneumo-mediastinum within the course of hospitalization. With the exception of one patient, all other patients developed pneumothorax as a late manifestation in their illness; more than 10 days after initial symptom onset in COVID-19. From within this case series, all patients who developed spontaneous pneumothorax or pneumo-mediastinum during hospitalization subsequently succumbed to the illness. Spontaneous pneumothorax or pneumo-mediastinum may be an important late manifestation in COVID-19; even in spontaneously breathing patients. This may be related to development of cystic changes within the lung parenchyma. Although the clinical relevance of this finding is unknown; in our series, it portended a worse prognosis in the majority of patients.
COVID-19 已成为影响全球超过 1100 万人的主要大流行病。COVID-19 的常见放射学表现包括周边性磨玻璃样或实变影；然而，气胸和纵隔气肿是非常罕见的表现；在未接受机械通气的患者中更为少见。我们报告了 5 例 COVID-19 患者的病例系列，这些患者在住院期间出现或发生自发性气胸或纵隔气肿。除了 1 例患者外，所有其他患者的气胸均在 COVID-19 初始症状出现 10 多天后作为疾病的晚期表现出现。在本病例系列中，所有在住院期间发生自发性气胸或纵隔气肿的患者随后都死于该疾病。自发性气胸或纵隔气肿可能是 COVID-19 的一个重要晚期表现；即使在自主呼吸的患者中也是如此。这可能与肺实质内囊性改变的发展有关。尽管目前尚不清楚这一发现的临床意义，但在我们的系列中，它预示着大多数患者预后更差。
