Abstract
Introduction: Spontaneous pneumothorax and pneumomediastinum are uncommon complications of COVID-19 viral pneumonia and these complications remain unknown largely. This study aimed to determine the relationship between pneumothorax, pneumomediastinum, and COVID-19 prognosis. Methods: Between March 2020 and January 2021, 82 COVID-19 (+) patients diagnosed with pneumothorax and pneumomediastinum were evaluated retrospectively. Data were obtained from the medical records of the patients, including demographic information, laboratory evaluations, radiological evaluations (PA lung, Thorax CT), clinical management, prognosis, and survival. Results: While 74 (90.2%) of the patients had COVID-19 proven by the laboratory, 8 (9.8%) patients were diagnosed based on their clinical picture and computed tomography (CT) findings. Seventy-six patients (92.7%) had pneumothorax, while 10 (12.1%) had additional pneumomediastinum and 6 patients (7.3%) isolated pneumomediastinum. There was no significant difference in the median duration of pneumothorax based on the presence (median: 8.55, IQR: 13) days) or absence (median: 2.5, IQR: 10) of mechanical ventilation (Mann-Whitney U Z=1.548, p=0.122). Most of the inflammatory markers as well as blood gas values differed significantly between the deceased and survived patients (p<0.05). Age, treatment groups, and the presence of comorbidities were the significant variables associated with survival in univariate analyses. A multivariate analysis revealed pH and sex as the only significant independent predictors of survival. Conclusion: Spontaneous pneumothorax and pneumomediastinum are rare complications of COVID-19 viral pneumonia. They can occur at any time during the course of the disease. In general, elderly patients with comorbidities who are exposed to mechanical ventilation seem to be at increased risk.
References
- World Health Organization (internet). WHO announces COVID-19 outbreak a pandemic 2020. https://www.who.int/ docs/default-source/coronaviruse/situation-reports/20200531- covid-19-sitrep-132.pdf? Sfvrsn=d9c2eaef_2.
- Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A. Coronavirus disease 2019 (COVID-19): A systematic review of imaging findings in 919 patients. AJR Am J Roentgenol .2020 Jul;215(1):87-93.
- Martinelli AW, Ingle T, Newman J, et al. COVID-19 and pneumothorax: A multicentre retrospective case series. Eur Respir J. 2020 Sep 9 ;56(5).
- Flower L, Carter JPL, Rosales Lopez J, Henry AM. Tension pneumothorax in a patient with COVID-19. BMJ Case Rep. 2020 May 17;13(5): e235861.
- Lu R, Zhao X, Li J, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020 Feb 22;395(10224):565–74.
- De Michele S, Sun Y, Yilmaz MM, et al. Forty Postmortem Examinations in COVID-19 Patients. Am J Clin Pathol. 2020 Nov 4 ;154(6):748–60.
- Wang W, Gao R, Zheng Y, Jiang L. COVID-19 with spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema. J Travel Med. 2020 Aug 20;27(5).
- Petrilli CM, Jones SA, Yang J, et al. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: Prospective cohort study. BMJ. 2020 May 22;369.
- McGuinness G, Zhan C, Rosenberg N, et al. Increased incidence of barotrauma in patients with COVID-19 on invasive mechanical ventilation. Radiology. 2020 Nov 1;297(2): E252–62.
- Ai T, Yang Z, Hou H, et al. Correlation of Chest CT and RT-PCR Testing for Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology. 2020 Aug1 ;296(2): E32–40.
- Sun R, Liu H, Wang X. Mediastinal emphysema, giant bulla, and pneumothorax developed during the course of COVID-19 Pneumonia. Korean J Radiol. 2020 May 1 ;21(5):541–4.
- Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020 Feb 15 ;395(10223):497–506.
- Hu B, Zeng LP, Yang X Lou, et al. Discovery of a rich gene pool of bat SARS-related coronaviruses provides new insights into the origin of SARS coronavirus. PLoS Pathog . 2017 Nov 30;13(11):e1006698.
- Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients with 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA - J Am Med Assoc. 2020 Mar 17;323(11):1061–9.
- Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020 Feb 15 ;395(10223):507–13.
- Sihoe ADL, Wong RHL, Lee ATH, et al. Severe acute respiratory syndrome complicated by spontaneous pneumothorax. Chest. 2004;125(6):2345–51.
- Ioannidis G, Lazaridis G, Baka S, et al. Barotrauma and pneumothorax. J Thorac Dis. 2015;7(Suppl 1):S38-43.
- Sheard S, Rao P, Devaraj A. Imaging of acute respiratory distress syndrome. Respir Care . 2012 Apr;57(4):607-12.
- Ucpinar BA, Sahin C, Yanc U. Spontaneous pneumothorax and subcutaneous emphysema in COVID-19 patient: Case report. J Infect Public Health.2020 ;13(6):887–9.
- Lin X, Gong Z, Xiao Z, Xiong J, Fan B, Liu J. Novel coronavirus pneumonia outbreak in 2019: Computed tomographic findings in two cases. Korean J Radiol. 2020 ;21(3):365–8.
- Zantah M, Dominguez Castillo E, Townsend R, Dikengil F, Criner GJ. Pneumothorax in COVID-19 disease- incidence and clinical characteristics. Respir Res. 2020 Sep 16;21(1):236.
- Park SJ, Park JY, Jung J, Park SY. Clinical manifestations of spontaneous pneumomediastinum. Korean J Thorac Cardiovasc Surg. 2016;49(4):287–91.
- Wang W, Gao R, Zheng Y, Jiang L. COVID-19 with spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema. J Travel Med . 2020 Aug 20;27(5):taaa062.
- Imam Z, Odish F, Gill I, et al. Older age and comorbidity are independent mortality predictors in a large cohort of 1305 COVID-19 patients in Michigan, United States. J Intern Med. 2020 Oct 1;288(4):469–76.
- Filice GA. SARS, pneumothorax, and our response to epidemics. Chest . 2004 Jun;125(6):1982-4.
Abstract
Giriş: Spontan pnömotoraks ve pnömomediastinum, COVID-19 viral pnömonisinin nadir görülen komplikasyonlarıdır ve bu komplikasyonlar büyük ölçüde bilinmemektedir. Bu çalışmada pnömotoraks, pnömomediastinum ve COVID-19 prognozu arasındaki ilişkiyi belirlemeyi amaçladık. Yöntemler: Mart 2020 ile Ocak 2021 arasında pnömotoraks ve pnömomediastinum tanısı alan 82 COVID-19 (+) hasta retrospektif olarak değerlendirildi. Demografik bilgiler, laboratuvar değerlendirmeleri, radyolojik değerlendirmeler (PA akciğer, Toraks BT), klinik yönetim, prognoz ve sağkalım dahil olmak üzere hastaların tıbbi kayıtlarından veriler elde edildi. Bulgular: Hastaların 74'ünde (%90,2) laboratuvar tarafından kanıtlanmış COVID-19 bulunurken, 8 (%9,8) hastaya klinik tablo ve bilgisayarlı tomografi (BT) bulgularına göre tanı konuldu. Yetmiş altı hastada (%92,7) pnömotoraks, 10 hastada (%12,1) ek olarak pnömomediastinum varken ve 6 hastada (%7,3) izole pnömomediasten vardı. Pnömotoraks süresinde mekanik ventilasyon varlığına (medyan: 8,55, IQR: 13) gün) veya yokluğuna (medyan: 2,5, IQR: 10) göre istatiksel anlamlı bir fark yoktu (Mann-Whitney UZ=1,548, p= 0,122). İnflamatuvar belirteçlerin çoğu ve kan gazı değerleri, ölen ve hayatta kalan hastalar arasında önemli ölçüde farklılık gösterdi (p<0,05). Tek değişkenli analizde yaş, tedavi grupları ve komorbiditelerin varlığı sağkalım ile ilişkili önemli değişkenlerdi. Çok değişkenli analizlerde, pH ve cinsiyetin hayatta kalmanın tek önemli bağımsız belirleyicisi olduğunu ortaya çıkardı. Sonuç: Spontan pnömotoraks ve pnömomediastinum, COVID-19 viral pnömonisinin nadir komplikasyonlarıdır. Hastalığın seyri sırasında herhangi bir zamanda ortaya çıkabilirler. Genel olarak, mekanik ventilasyona maruz kalan komorbiditeleri olan yaşlı hastalar artmış risk altında görünmektedir.
References
- World Health Organization (internet). WHO announces COVID-19 outbreak a pandemic 2020. https://www.who.int/ docs/default-source/coronaviruse/situation-reports/20200531- covid-19-sitrep-132.pdf? Sfvrsn=d9c2eaef_2.
- Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A. Coronavirus disease 2019 (COVID-19): A systematic review of imaging findings in 919 patients. AJR Am J Roentgenol .2020 Jul;215(1):87-93.
- Martinelli AW, Ingle T, Newman J, et al. COVID-19 and pneumothorax: A multicentre retrospective case series. Eur Respir J. 2020 Sep 9 ;56(5).
- Flower L, Carter JPL, Rosales Lopez J, Henry AM. Tension pneumothorax in a patient with COVID-19. BMJ Case Rep. 2020 May 17;13(5): e235861.
- Lu R, Zhao X, Li J, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020 Feb 22;395(10224):565–74.
- De Michele S, Sun Y, Yilmaz MM, et al. Forty Postmortem Examinations in COVID-19 Patients. Am J Clin Pathol. 2020 Nov 4 ;154(6):748–60.
- Wang W, Gao R, Zheng Y, Jiang L. COVID-19 with spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema. J Travel Med. 2020 Aug 20;27(5).
- Petrilli CM, Jones SA, Yang J, et al. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: Prospective cohort study. BMJ. 2020 May 22;369.
- McGuinness G, Zhan C, Rosenberg N, et al. Increased incidence of barotrauma in patients with COVID-19 on invasive mechanical ventilation. Radiology. 2020 Nov 1;297(2): E252–62.
- Ai T, Yang Z, Hou H, et al. Correlation of Chest CT and RT-PCR Testing for Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology. 2020 Aug1 ;296(2): E32–40.
- Sun R, Liu H, Wang X. Mediastinal emphysema, giant bulla, and pneumothorax developed during the course of COVID-19 Pneumonia. Korean J Radiol. 2020 May 1 ;21(5):541–4.
- Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020 Feb 15 ;395(10223):497–506.
- Hu B, Zeng LP, Yang X Lou, et al. Discovery of a rich gene pool of bat SARS-related coronaviruses provides new insights into the origin of SARS coronavirus. PLoS Pathog . 2017 Nov 30;13(11):e1006698.
- Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients with 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA - J Am Med Assoc. 2020 Mar 17;323(11):1061–9.
- Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020 Feb 15 ;395(10223):507–13.
- Sihoe ADL, Wong RHL, Lee ATH, et al. Severe acute respiratory syndrome complicated by spontaneous pneumothorax. Chest. 2004;125(6):2345–51.
- Ioannidis G, Lazaridis G, Baka S, et al. Barotrauma and pneumothorax. J Thorac Dis. 2015;7(Suppl 1):S38-43.
- Sheard S, Rao P, Devaraj A. Imaging of acute respiratory distress syndrome. Respir Care . 2012 Apr;57(4):607-12.
- Ucpinar BA, Sahin C, Yanc U. Spontaneous pneumothorax and subcutaneous emphysema in COVID-19 patient: Case report. J Infect Public Health.2020 ;13(6):887–9.
- Lin X, Gong Z, Xiao Z, Xiong J, Fan B, Liu J. Novel coronavirus pneumonia outbreak in 2019: Computed tomographic findings in two cases. Korean J Radiol. 2020 ;21(3):365–8.
- Zantah M, Dominguez Castillo E, Townsend R, Dikengil F, Criner GJ. Pneumothorax in COVID-19 disease- incidence and clinical characteristics. Respir Res. 2020 Sep 16;21(1):236.
- Park SJ, Park JY, Jung J, Park SY. Clinical manifestations of spontaneous pneumomediastinum. Korean J Thorac Cardiovasc Surg. 2016;49(4):287–91.
- Wang W, Gao R, Zheng Y, Jiang L. COVID-19 with spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema. J Travel Med . 2020 Aug 20;27(5):taaa062.
- Imam Z, Odish F, Gill I, et al. Older age and comorbidity are independent mortality predictors in a large cohort of 1305 COVID-19 patients in Michigan, United States. J Intern Med. 2020 Oct 1;288(4):469–76.
- Filice GA. SARS, pneumothorax, and our response to epidemics. Chest . 2004 Jun;125(6):1982-4.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | August 1, 2022 |
| Published in Issue | Year 2022 Volume: 3 Issue: 2 |
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