Spontaneous Pneumothorax and Pneumomediastinum in COVID-19 Pneumonia

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.