Pulmonary embolism, spontaneous pneumomediastinum and subcutaneous emphysema in a patient with COVID-19 disease: A case report

The pathophysiology of pulmonary embolism (PE) and pneumomediastinum (PNM) in COVID-19 patients remain unclear. Studies indicate that the infection of the endothelial cells by the virus perpetuates a storm of cytokines and thrombogenic factors, which cause endothelium injury. We present a unique, to our knowledge, case of a patient aged 56 years with COVID-19 pneumonia who was admitted with dyspnea, desaturation, and fever. His situation was complicated by both PNM and PE. He received appropriate treatment with a therapeutic dose of low molecular weight heparin, and exhibited clinical improvement and resolution of the subcutaneous emphysema. Clinicians should suspect both PE and PNM within the differential diagnosis in cases of COVID-19 patients with pleuritic pain, dyspnea, and respiratory failure, after the tenth day from the onset of symptoms.