Spontaneous pneumomediastinum in a 65-year-old patient with COVID-19 pneumonia.
A 65-year-old male patient came to the intensive care unit with respiratory distress. The patient did not have a significant medical or surgical history. He was not under any treatment, nor did he smoke cigarettes. His history revealed an influenza-like illness, fever, arthralgia and myalgia associated with anosmia and a dry cough. He had also come in contact with a positive COVID-19 patient. This article discusses the case of a 65-year-old patient with spontaneous pneumomedisatinum with COVID-19 pneumonia.
Spontaneous pneumomediastinum is free air in the mediastinum without any trauma.
Clinical examination showed that the patient was conscious and had tachypnea 24 cycles/minute with an O2 saturation of 88% in ambient air and 93% under 2L/min of oxygen. His heart rate was 82 beats per minute and blood pressure 120/80 mmHg. Pulmonary auscultation was remarkable of high-sounding gasps and sibilant in bilateral. Heart sounds were normal with no audible breath with no sign of right or left heart failure.
Diagnosis and treatment
The patient’s biological assessment was consistent with an aspecific inflammatory syndrome and lymphopenia. However, other lab tests, hemoglobin and kidney function were normal. موقع المراهنات على المباريات Chest CT scan showed bilateral, peripheral and subpleural ground-glass opacities associated with foci band condensation. The findings were suggestive of SARS-CoV-2. Polymerase chain reaction confirmed the diagnosis. العاب قمار حقيقية
He gradually presented with dyspnea at rest and signs of struggle associated with moderate to severe basal thoracic pain. Therefore, he required oxygen therapy with a high concentration facial mask reaching up to 12 L/min. Radiograph of his front chest showed a stationary aspect of the lesion with bilateral reticulonodular opacities that were more marked on the right side with an intestinal syndrome. قمار على النت
The patient showed no improvement after treatment with hydroxychloroquine and azithromycin. Doctors prescribed an immunoglobulin treatment at a rate of 1 g/kg for 5 days. In addition, he was given two doses of tocilizumab 400 mg at 48 h interval.
Repeat CT scan of the chest on the 16th day revealed a spontaneous pneumomediastinum. However, there were no signs of subcutaneous emphysema or pulmonary embolism. His respiratory rate, oxygen saturation, heart rate and blood pressure were monitored. In addition, he was given a topical analgesic cream for chest pain.
The patient showed partial improvement in respiratory symptoms after a few days. He did not have any symptoms after 31 days. He was declared cured after repeating the PCR test at a difference of 24 hours. The results were negative both times.
References
Spontaneous Pneumomediastinum Associated with COVID-19 Pneumonia https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7584954/
