TP47. TP047 COVID AND ARDS CASE REPORTS最新文献

{"title":"Crazy-Paving as a Radiological Finding of COVID-19 Infection","authors":"H. Rovnan, M. Young","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2459","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2459","url":null,"abstract":"Since the SARS-CoV-2 virus appeared in December of 2019 resulting in a world-wide pandemic, science has been trying to keep up with how to accurately identify symptoms, diagnose, and treat the novel infection. It was evident that infection resulted in upper respiratory tract symptoms, with the lungs being most commonly affected1. Clinicians have been scrambling to identify radiographic findings that could predict infection with the virus. Computed tomography (CT) scanning of the chest has become the modality of choice. Ground glass opacities (GGO) are identified in a large majority of cases but other radiographic changes such as laterality, consolidation, lobe involvement, and vascular abnormalities also give signal to COVID-19. In this case, COVID-19 resulted in a crazy-paving pattern which has only been found in 34.9% of COVID-19 patients2. Introduction: More than 70% of COVID patients have CT abnormalities that include GGO, vascular enlargement, bilateral abnormalities, lower lobe involvement, and posterior predilection. We present a case of a linear pattern superimposed on a background of GGO resembling irregularly shaped paving stones, “crazy paving”. Case presentation: A 92 year old female with a past medical history of hypertension, chronic kidney disease, reflux, and immune thrombocytopenic purpura presented to the emergency department with cough, nausea and fatigue for two days. She was afebrile and exam revealed new onset atrial fibrillation. Laboratory studies showed thrombocytopenia of 62 k/mcL, elevated lactate dehydrogenase of 443 U/L, and elevated CRP of 7.4 mg/dL. Chest radiography showed a questionable opacity in the right upper lobe concerning for pneumonia. Rapid antigen testing for Sars-CoV-2 returned positive. She developed progressively worsening hypoxemia and dyspnea prompting a chest CT scan that was negative for pulmonary embolism, but GGO were noted in the right upper and lower lobes with a crazy-paving appearance. Remdesivir, dexamethasone, and convalescent plasma was administered. She improved and was discharged to an inpatient rehabilitation facility. Discussion: Crazypaving can be seen in many conditions - most commonly pulmonary edema, infection, hemorrhage, acute interstitial pneumonia, adult respiratory distress syndrome, radiation pneumonitis and eosinophilic pneumonia3. Several systematic reviews and meta-analyses found crazy-paving in 34.9% of CT scans of the chest in patients with COVID-192. This case highlights crazy-paving as a radiographic finding on CT scan of the chest. Conclusion: It is evident that as more data accumulates about radiographic findings and treatment of COVID-19, that COVID- 19 does not have pathognomonic radiological findings.","PeriodicalId":181364,"journal":{"name":"TP47. TP047 COVID AND ARDS CASE REPORTS","volume":"61 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126245374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 Pneumonia: Guiding the Decision to Intubate Based on Independent Assessment of Oxygenation and Work of Breathing","authors":"A. Shahid, A. Nadeem, P. Fanapour, Mylene Apigo, S. Kim, M. Khan, C. Patel, R. Carnate, R. Gazmuri","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2447","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2447","url":null,"abstract":"With the emergence of COVID-19, healthcare worldwide is afflicted. While there is a spectrum of disease severity and presenting symptoms in infected patients, hypoxemic respiratory failure is the leading cause of mortality. Decision to intubate in rapidly deteriorating patients plays a significant role in determining patient outcome. In most patients, COVID-19 pneumonia initially causes worsening hypoxemia but minimal impairment of lung compliance which determines the work of breathing (WOB). Once adequate arterial oxygenation is established, a tool to determine WOB independent of oxygen needs can guide the decision to intubate for invasive mechanical ventilation (IMV). We monitored oxygen requirements and WOB in 14 patients admitted to our ICU with severe COVID-19 pneumonia. All patients had radiographic evidence of extensive lung disease, significant hypoxemia and multiple comorbidities. Hypoxemia was managed through non-invasive means, predominantly using highflow nasal cannula. To assess WOB, we used a scale developed by us assigning points to the respiratory rate and use of respiratory accessory muscles (range, 1 to 7) (Figure 1a). This was used at the time of initial evaluation and throughout the ICU stay. Out of 14 patients, 10 did not require intubation and recovered while 4 were intubated. We compared the maximum and average WOB of the non-intubated patients throughout their ICU stay with the WOB of intubated patients measured within 24 hours before intubation (Figure 1b). The maximal and the average WOB were higher in patients requiring intubation (mean ± SD, maximal 4.3 ± 0.9 vs 5.5 ± 1.0 pts, p = 0.028 and average 2.7 ± 0.6 vs 3.9 ± 0.5 pts, p = 0.002). Breakdown of the various WOB components demonstrated a statistically significantly higher maximal and average use of respiratory accessory muscles (assessed as their aggregate sum) and higher average respiratory rate in intubated patients. However, the maximal respiratory rate was not significantly higher. Our data illustrates the initial response to COVID-19 lung injury is tachypnea which can be sustained with adequate oxygenation. As lung injury progresses with more recruitment of respiratory accessory muscles, intubation for IMV becomes necessary. Our WOB scale becomes a useful tool to assist in the decision of when to intubate. It is simple to teach, apply and incorporate into routine patient assessment. We recommend routine and systematic WOB assessment to plan for orderly nonemergent intubations for IMV. Further refinement on the interventions recommended based on specific WOB level and other modifying factors is awaited.","PeriodicalId":181364,"journal":{"name":"TP47. TP047 COVID AND ARDS CASE REPORTS","volume":"169 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123738740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Massive Pneumomediastinum, Pneumoperitoneum, Subcutaneous Emphysema in SARS-COVID-2 Patient During CPAP Support, Treated by Lateral and Prone Positioning","authors":"N. Petrucci","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2463","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2463","url":null,"abstract":"Introduction Pneumomediastinum (PM) is defined as the presence of free air in the mediastinal cavity. PM may present independently or concurrently with Pneumoperitoneum (PP) and other manifestation of free air. We present a rare Case of massive PM associated with extensive PP and Subcutaneous Emphysema in a SARSCOVID- 2 patient occurred during spontaneous ventilation in CPAP with face-mask. Description A 53-year-old, previously healthy man was admitted to Hospital after 7 days of fever, cough and fatigue, plus worsening dyspnea in the last two days. The body temperature was 39°C, Heart Rate 115 beats/minute and Respiratory Rate (RR) 28 breaths/minute with normal Blood Pressure (125/75 mmHg). The Oxygen Saturation was 86% despite oxygen supplementation by Ventimask 0.50 FiO2. Chest X-ray showed bilateral patchy opacities and he tested positive for SARS-COVID-2 in a nasopharyngeal swab.Support non-invasive ventilation was started using 10 cmH2O CPAP by total face mask. Despite the ventilatory support and increasing FiO2 till 80%, after 3 days the patient worsened, RR was 32 breaths/minute with visible inspiratory effort and attempt to increase tidal volume. Examination of the head and neck revealed crepitus on palpation. On auscultation heartbeat was inaudible, as well as breath sounds at the apex and parasternal, bilaterally. A total-body CT scan showed a massive PM (25 cm transverse and 8.9 cm anterior-posterior) and PP (Fig.1a). The patient was intubated and transferred to the ICU. Tracheoscopy did not show tear or leakage in the tracheal wall. The patient was put on lung protective ventilation with 6 ml/Kg IBW at 100% FiO2 and zero PEEP. The PaO2/FiO2 ratio was below 100. After 3 days, gas exchange and subcutaneous emphysema did not improved, so a further CT scan was performed, showing persistence of the PM. Thoracic surgery consultation suggested to drain the air by parasternal approach, but we noted that during nursing manoeuvres, rolling left and right, the cardiac tone returned audible. Thus, we put the patient on lateral and prone position alternatively. After 48 hours, the PM resolved completely and gas exchange improved (Fig. 1b). Discussion PM could be a complication of COVID disease due to barotrauma and lung frailty. This Case shows that massive PM can occur during CPAP in COVID patient spontaneously breathing, and it can be treated non invasively. PM resolved quickly by lateral and prone positioning. This Case is a reminder that PM should be excluded if acute deterioration occurs in a COVID-19 patient.","PeriodicalId":181364,"journal":{"name":"TP47. TP047 COVID AND ARDS CASE REPORTS","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125634182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of Pulmonary Fibrosis in Coronavirus Disease 2019 (COVID-19) Patients: A Case Series","authors":"K. Ghosh, G. Ibarra, M. R. V. Espiritu, A. Poor, N. Trenard","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2435","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2435","url":null,"abstract":"Introduction: SARS-CoV-2, the cause of COVID-19, was first identified in December 2019 and declared a pandemic by the WHO in March 2020. Knowledge about COVID-19 is growing exponentially, but long-term pulmonary outcomes and factors influencing the development of fibrosis, such as intubation status, remain uncertain. We present three patients with no previous underlying pulmonary disease who developed post-ARDS fibrosis secondary to COVID-19 and continue to be severely impaired six months after initial hospitalization. Case Series: Three patients developed post-ARDS pulmonary fibrosis secondary to COVID-19 within one month of acute infection. Two males and one female, aged 56 to 75, were admitted 4 to 7 days after symptom onset and required ICU admission. One patient required 12 days of mechanical ventilation and was managed with noninvasive pressure ventilation (NIPPV) for 15 days and one was managed with HFNC for 37 days. One patient receiving oxygenation via HFNC and oxymask developed pneumomediastinum on day 30 of admission and was managed conservatively. All patients demonstrated characteristic bilateral ground-glass opacities on CT chest and follow up scans showed traction-bronchiectasis with diffuse fibrotic changes. C-reactive protein level on admission ranged from 41.22 to 30.79, and all patients received systemic corticosteroids along with therapeutic anticoagulation. All patients met criteria for home oxygen on discharge. Discussion: Post-ARDS pulmonary fibrosis in COVID-19 appears to be multifactorial. Possible outcome predictors identified include: advanced age, illness severity, length of ICU stay, mechanical ventilation, smoking, and chronic alcoholism. While the mechanism remains uncertain, virus-induced cell injury and inflammatory mediators may be responsible for the accelerated lung damage observed. Management has evolved over the course of the pandemic from emphasis on early intubation to maximal use of non-invasive pressure ventilation, taking into consideration the potential harm associated with patient self-inflicted lung injury versus ventilator induced injury. Our case series demonstrates three patients with varying comorbidities and elevated inflammatory markers, who received steroids and therapeutic anticoagulation. All patients had similar clinical outcomes irrespective of intubation status. Conclusion: Intubation status did not appear to have an impact on progression to post-ARDS pulmonary fibrosis in our case series of three patients. All patients developed fibrosis and continued to experience severe dyspnea requiring home oxygen six months after acute infection. Long-term observational cohort studies are required to better establish if mechanical ventilation is a predictor of post-ARDS pulmonary fibrosis from COVID-19.","PeriodicalId":181364,"journal":{"name":"TP47. TP047 COVID AND ARDS CASE REPORTS","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116202897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cryptococcal Meningoencephalitis in an HIV-Negative Host Infected with COVID-19","authors":"A. C. Prandecki, A. Iardino, Kushal Patel, N. Kirsch, E. Wang, M. Kioka","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2432","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2432","url":null,"abstract":"Introduction: Cryptococcosis, a fungal infection caused by the yeast Cryptococcus neoformans, is a frequently encountered infection in immunocompromised hosts, including those with HIV infection, long-term corticosteroid use, solid organ transplants, and hematologic malignancies. Common presentations include meningoencephalitis and pneumonia. Cryptococcal meningoencephalitis does rarely occur in patients with no apparent underlying disease or risk factors with an associated poor prognosis. Case: A 52-year-old male with a history of uncontrolled diabetes and alcohol dependence presented to our hospital secondary to a fall and confusion. His initial physical examination revealed tachycardia and disorientation. Laboratory studies at the time demonstrated mild hyponatremia, ketonemia, mildly elevated transaminases, and hyperglycemia. Additionally, a COVID-19 PCR was positive. Radiographs obtained in the ED were unremarkable, but computed tomographic angiogram of the chest revealed ground-glass opacities in the left upper lobe. Thereafter, the patient was begun on Azithromycin and Ceftriaxone for treatment of possible community-acquired pneumonia. Due to his continued altered mentation and increasing lethargy, computed tomography of the head was obtained, which revealed new areas of low attenuation in multiple periventricular and subcortical white matter areas, suggestive of infectious or inflammatory encephalitis. Thereafter, a lumbar puncture was performed and cerebrospinal fluid (CSF) studies and microbiology were obtained. These studies revealed evidence of infection with Cryptococcus neoformans/gatti, hyperproteinorachia of 392, hypoglycorrhachia of 38, and mononuclear pleocytosis of 97. Prior to speciation of the patient's cultures, he was placed on empiric antibiotics and antiviral coverage for infectious meningoencephalitis. After discovery of the patient's infectious agent, his treatment regimen was narrowed to Amphotericin B and Flucytosine. Additionally, workup for HIV was initiated, with findings of decreased CD4 count in the absence of positive HIV serologies. As the patient's treatment for COVID-19 and Cryptococcosis progressed, his CD4 count later spontaneously corrected. Discussion: This case is significant because it demonstrates a case of Cryptococcal meningoencephalitis in a patient with transient lymphocytopenia and active COVID-19 infection. In the literature, it has been demonstrated that there is a significant correlation between COVID-19 infection and low CD4 and CD8 counts. Therefore, in this particular case, it is possible that infection with COVID-19 in combination with increased infection risk from inadequately managed diabetes and daily alcohol use predisposed the patient to transient lymphopenia, leading to Cryptococcosis. Ultimately, it is imperative that physicians be aware of any etiology that may predispose patients to infections with uncommon microbes, particularly in the absence of typical predisposing factors.","PeriodicalId":181364,"journal":{"name":"TP47. TP047 COVID AND ARDS CASE REPORTS","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127645467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elizabethkingia Meningoseptica sepsis Associated with COVID-19 Infection: An Emerging Nosocomial Pathogen","authors":"M. S. Rahi, K. Amoah, K. Gunasekaran, R. Kapil, J. Kwon","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2455","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2455","url":null,"abstract":"Elizabethkingia meningoseptica is a multi-drug resistant, aerobic, gram-negative bacteria known for causing nosocomial infections and high mortality in critically ill patients. A 68-year-old male with a past medical history significant for hypertension and stroke presented to the emergency department with worsening cough and shortness of breath ten days after being diagnosed with Coronavirus Disease-2019 (COVID-19) infection. He also endorsed fatigue, fever, loss of smell, and diarrhea. He denied any chest pain, nausea and vomiting. On examination, he was febrile with a temperature of 102.2-degree Fahrenheit, heart rate of 145 beats/minute, blood pressure of 120/90 mm of Hg, respiratory rate of 24 breaths/minute, and oxygen saturation of 85% while breathing ambient air. Laboratory data revealed a leukocytosis of 12,000/μL, elevated serum creatinine of 1.38 mg/dL, D-dimer of 4.36 mg/L, C-reactive protein of 18 mg/dL and markedly elevated ferritin of 2500 ng/mL. Chest radiograph showed patchy bilateral alveolar infiltrates. His clinical presentation was consistent with severe COVID-19 infection causing acute respiratory distress syndrome. The patient was initiated on bi-level positive pressure ventilation, but his respiratory status continued to worsen, requiring intubation and mechanical ventilation. He was managed with low tidal volume ventilation and ARDS-network protocol. Treatment with remdesivir, dexamethasone, and convalescent plasma was initiated. On day 10 of admission patient developed fever, increasing oxygen requirement, and hypotension concerning for sepsis. Empiric treatment with vancomycin and piperacillin-tazobactam was started after obtaining blood cultures, which grew Elizabethkingia meningoseptica resistant to all beta-lactam antibiotics (penicillins and cephalosporins). Intravenous trimethoprimsulfamethoxazole was started but later switched to clindamycin due to electrolyte abnormalities. Therapy was continued for two weeks, and repeat blood cultures were sterile. His hospital course was complicated by prolonged ventilator weaning, acute kidney injury, and hospital-acquired pneumonia. He was successfully extubated to a high-flow nasal cannula after twenty days and is currently being managed for delirium. Elizabethkingia meningoseptica causes neonatal meningitis and nosocomial sepsis in older adults with underlying chronic comorbidities or immunocompromised status like an organ transplant receiving immunosuppressive therapy, uncontrolled diabetes mellitus, and end-stage renal disease. Mortality is high and ranges from 30%- 50%. It is usually resistant to beta-lactam antibiotics, carbapenems, and aminoglycosides. Some isolates have shown varying susceptibility to fluoroquinolones, trimethoprim-sulfamethoxazole, minocycline, and tigecycline. With the increasing use of steroids and prolonged critical illness in patients with COVID-19 infection, this emerging pathogen is a paramount health concern during the pandemic.","PeriodicalId":181364,"journal":{"name":"TP47. TP047 COVID AND ARDS CASE REPORTS","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131042130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous Pneumomediastinum: A Rare Complication of COVID-19 Pneumonia","authors":"M. Alam, K. Hussain, C. Clagett","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2466","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2466","url":null,"abstract":"A novel coronavirus was identified at the end of December 2019 as the cause of a cluster of pneumonia cases in Wuhan, China. The virus that causes Coronavirus diseases-19 ( COVID-19) is designated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The clinical manifestations of COVID -19 and complications are evolving. Cardiac, renal, neurologic complication and coagulopathy has been reported in the literature. Here we present a case of spontaneous pneumomediastinum who tested positive for COVID -19 . A 45 years old female who was admitted after a reverse transcriptase-polymerase chain reaction (RT-PCR) test-confirmed COVID-19. She was experiencing worsening dyspnea. Initial laboratory investigation showed white blood cells of 7.49 [differential: 80.5% neutrophils and 13.6% lymphocytes]. Procalcitonin was 0.12, lactate dehydrogenase was 701, ferritin was 586, fibrinogen was more than 600, D-dimer was 0.56, CRP was 9.9. Arterial blood gas showed pH 7.44, PCO2 54 mmHg, and PO2 85.7 mmHg on 85% FiO2 heated high flow nasal cannula oxygen. A chest x-ray showed bilateral interstitial and alveolar opacities. A diagnosis of acute respiratory distress syndrome (ARDS) was made. Despite maximum high flow oxygen patient continues to desaturate and the patient was started on BiPAP with 100% FiO2 with the improvement of hypoxia. The patient continued on Covid specific therapy including dexamethasone. The patient remained BiPAP dependent with intermittent heated high flow nasal cannula with positive pressure support. On the 15-day of hospitalization, the patient noted to have worsening hypoxia, emergent computed tomography angiogram(CTA) of the chest was done which revealed extensive pneumomediastinum. Esophagogram was obtained and esophageal rupture was ruled out. The patient was treated conservatively and monitored for any further complications. On day 43 patient was discharged on 2liter nasal cannula oxygen. Spontaneous pneumomediastinum (SPM) is a rare clinical entity. SPM occurs when the air leak through the small alveolar ruptures into the surrounding bronchovascular sheath. SPM also could result from air leaks from the esophageal or endobronchial rupture. The exact mechanism is unknown but the proposed mechanism is likely via the differential pressure gradient that develops between the Alveoli and lung interstitium. Barotrauma from mechanical ventilation accounts for one-third of the cases of pneumomediastinum. In our case patient was not on mechanical ventilation and esophageal rupture was ruled out by esophagogram, so we believe it is a spontaneous pneumomediastinum. We believe prolonged positive pressure ventilation could lead to rupture of the alveoli in COVID-19 pneumonia, leading to spontaneous pneumomediastinum.","PeriodicalId":181364,"journal":{"name":"TP47. TP047 COVID AND ARDS CASE REPORTS","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125528704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}