Spontaneous subcutaneous emphysema and pneumomediastinum in non-intubated patients with COVID-19

被引:52
作者
Manna, Sayan [1 ]
Maron, Samuel Z. [1 ]
Cedillo, Mario A. [1 ]
Voutsinas, Nicholas [1 ]
Toussie, Danielle [1 ]
Finkelstein, Mark [1 ]
Steinberger, Sharon [1 ]
Chung, Michael [1 ]
Bernheim, Adam [1 ]
Eber, Corey [1 ]
Gupta, Yogesh Sean [1 ]
Concepcion, Jose [1 ]
Libes, Richard [1 ]
Jacobi, Adam [1 ]
机构
[1] Icahn Sch Med Mt Sinai, Mt Sinai Hosp, Dept Diagnost Mol & Intervent Radiol, New York, NY 10029 USA
关键词
Subcutaneous emphysema; Pneumomediastinum; COVID-19; CORONAVIRUS DISEASE 2019; COMPLICATIONS;
D O I
10.1016/j.clinimag.2020.08.013
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
Purpose: We describe the presenting characteristics and hospital course of 11 novel coronavirus (COVID-19) patients who developed spontaneous subcutaneous emphysema (SE) with or without pneumomediastinum (SPM) in the absence of prior mechanical ventilation. Materials and methods: A total of 11 non-intubated COVID-19 patients (8 male and 3 female, median age 61 years) developed SE and SPM between March 15 and April 30, 2020 at a multi-center urban health system in New York City. Demographics (age, gender, smoking status, comorbid conditions, and body-mass index), clinical variables (temperature, oxygen saturation, and symptoms), and laboratory values (white blood cell count, C-reactive protein, D-dimer, and peak interleukin-6) were collected. Chest radiography (CXR) and computed tomography (CT) were analyzed for SE, SPM, and pneumothorax by a board-certified cardiothoracic-fellowship trained radiologist. Results: Eleven non-intubated patients developed SE, 36% (4/11) of whom had SE on their initial CXR. Concomitant SPM was apparent in 91% (10/11) of patients, and 45% (5/11) also developed pneumothorax. Patients developed SE on average 13.3 days (SD: 6.3) following symptom onset. No patients reported a history of smoking. The most common comorbidities included hypertension (6/11), diabetes mellitus (5/11), asthma (3/11), dyslipidemia (3/11), and renal disease (2/11). Four (36%) patients expired during hospitalization. Conclusion: SE and SPM were observed in a cohort of 11 non-intubated COVID-19 patients without any known cause or history of invasive ventilation. Further investigation is required to elucidate the underlying mechanism in this patient population.
引用
收藏
页码:207 / 213
页数:7
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