Pneumology department, University Hospital Center of Tangier, Tetouan, AL-Hoceima.
Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Morocco.
Medicine (Baltimore). 2023 Jan 6;102(1):e32605. doi: 10.1097/MD.0000000000032605.
Current evidence suggests that intrathoracic gas effusions (pneumomediastinum and pneumothorax) may be observed among COVID-19 patients even without mechanical ventilation. Here, we report 9 patients who developed spontaneous intrathoracic gas effusions in the absence of mechanical ventilation. The incidence of spontaneous intrathoracic gas effusions is low at 0.5% in hospitalized COVID-19 patients in the absence of respiratory support. Two patients (22.2%) had spontaneous pneumomediastinum, with or without subcutaneous emphysema. Three patients (33.3%) had pneumomediastinum associated with pneumothorax, with or without subcutaneous emphysema, and 4 patients (44.4%) had spontaneous pneumothorax. The Pneumothorax was unilateral in 66.6% of cases (6/9) but without location preference. Five of our patients were smokers, of whom 80% had isolated spontaneous pneumothorax. Other comorbidities included pulmonary tuberculosis in a single patient, diabetes in 2 patients and arterial hypertension in 1 patient. None of the patients had respiratory comorbidities. All of our patients were male. The average duration of hospital stay was 10 days (±6.63). All patients required oxygen therapy. Three patients (33.3%) with spontaneous pneumothorax required chest drainage. The evolution was favorable in 6 patients (66.7%) and worse in 3 cases (33.3%). The respiratory manifestations of COVID-19 have been stereotyped. Intrathoracic effusions may also be signs of COVID-19 with varying prognoses, or even the only presentation of the disease. This should be considered in clinical practice, and doctors are encouraged to request a SARS-CoV-2 test in this situation. Further investigations with a larger sample size are needed to identify the prognostic factors in COVID-19 patients with gas effusions.
目前的证据表明，即使没有机械通气，COVID-19 患者也可能出现胸腔内气体渗出（纵隔气肿和气胸）。在此，我们报告了 9 例在没有机械通气的情况下发生自发性胸腔内气体渗出的患者。在没有呼吸支持的住院 COVID-19 患者中，自发性胸腔内气体渗出的发生率较低，为 0.5%。2 例患者（22.2%）发生自发性纵隔气肿，伴或不伴皮下气肿。3 例患者（33.3%）发生纵隔气肿合并气胸，伴或不伴皮下气肿，4 例患者（44.4%）发生自发性气胸。气胸在 66.6%（6/9）的病例中为单侧，但无位置偏好。我们的 5 名患者为吸烟者，其中 80%的患者为孤立性自发性气胸。其他合并症包括 1 例肺结核、2 例糖尿病和 1 例动脉高血压。所有患者均无呼吸系统合并症。我们所有的患者均为男性。平均住院时间为 10 天（±6.63）。所有患者均需要氧疗。3 例自发性气胸患者需要胸腔引流。6 例（66.7%）患者病情好转，3 例（33.3%）患者病情恶化。COVID-19 的呼吸道表现已经定型。胸腔内积液也可能是 COVID-19 的标志，其预后各不相同，甚至可能是该病的唯一表现。在临床实践中应考虑到这一点，并鼓励医生在这种情况下进行 SARS-CoV-2 检测。需要进一步开展更大样本量的研究以确定有气体渗出的 COVID-19 患者的预后因素。
