Antony Manoj Matthew, Achappa Basavaprabhu, Victor Dsouza Nikhil, Sundar Shruti, Bs Vinay
Department of Internal Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India E-mail:
Department of Internal Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India.
Qatar Med J. 2022 Jun 4;2022(3):19. doi: 10.5339/qmj.2022.19. eCollection 2022.
Since the beginning of the COVID-19 pandemic, several infected patients have suffered from unusual and severe complications. Among these rare complications, pneumothorax and pneumomediastinum have attracted clinical attention. Such complications might be challenging to diagnose immediately because of the atypical presentation in some cases. Accurate diagnosis is essential to ensure effective treatment. Here, we present the case of a 62-year-old male who presented with symptoms of COVID-19 acute respiratory distress. There was diffuse subcutaneous emphysema in the face, neck, shoulder, and chest wall on clinical examination. The patient was started on oxygenation via a non-rebreather mask. On further evaluation, his chest X-ray revealed bilateral peripheral opacities in the lung fields, bilateral pneumothorax, and subcutaneous emphysema, after which intercostal drainage tubes were inserted. The patient's oxygen saturation was not satisfactory, and he was switched to a high-flow nasal cannula. However, his condition deteriorated, and he was put on mechanical ventilation and inotropic support. Despite our best efforts, the patient succumbed to the disease. We want to emphasize the importance of this adverse event despite his nonsmoking history and the exclusion of positive pressure ventilation. Although benign, early diagnosis of this condition is vital, as the condition could lead to worse morbidity if left unrecognized.
自新冠疫情开始以来，数名感染患者出现了异常严重的并发症。在这些罕见并发症中，气胸和纵隔气肿引起了临床关注。由于某些病例表现不典型，此类并发症可能难以立即诊断。准确诊断对于确保有效治疗至关重要。在此，我们报告一例62岁男性患者，其表现为新冠急性呼吸窘迫症状。临床检查发现面部、颈部、肩部和胸壁有弥漫性皮下气肿。患者开始通过非重复呼吸面罩进行氧疗。进一步评估时，其胸部X线显示双肺野周边模糊影、双侧气胸和皮下气肿，随后插入肋间引流管。患者的氧饱和度不理想，遂改用高流量鼻导管吸氧。然而，其病情恶化，接受了机械通气和血管活性药物支持治疗。尽管我们竭尽全力，患者仍因病死亡。我们想强调这一不良事件的重要性，尽管他无吸烟史且排除了正压通气因素。虽然这种情况较为少见，但早期诊断至关重要，因为如果未被识别，病情可能导致更严重的发病率。
