SHM Converge Scientific Abstract ePoster Gallery-Take a Conservative Approach to Managing Pneumomediastinum in Covid-19 Infection

Pdf Summary

This case describes a 69-year-old man with COVID-19 pneumonia who developed extensive pneumomediastinum and subcutaneous emphysema during hospitalization. He initially presented for psychiatric concerns and was found to have worsening respiratory status, fever, elevated inflammatory markers, and bilateral lung opacities on chest X-ray. His oxygen requirement progressively increased, leading to ICU transfer and treatment with remdesivir, dexamethasone, therapeutic enoxaparin, and baricitinib. When his D-dimer rose markedly, CT angiography ruled out pulmonary embolism but revealed pneumomediastinum.<br /><br />Cardiothoracic surgery recommended conservative treatment rather than intervention, with close monitoring using daily chest X-rays. The patient gradually improved, the mediastinal air resolved, and he was eventually discharged breathing room air.<br /><br />The report highlights that pneumomediastinum, though rare, is being reported more often in COVID-19 pneumonia. The likely mechanism is the Macklin effect: severe alveolar injury and increased pressure from coughing or labored breathing cause alveolar rupture, allowing air to track along bronchovascular sheaths into the mediastinum. Because the condition is usually self-limited, management is often conservative unless there is persistent air leak or evidence of cardiopulmonary compromise, in which case thoracic surgery may be needed.<br /><br />Overall, the case supports a conservative approach with serial imaging and clinical monitoring for pneumomediastinum in COVID-19 patients.

Asset Subtitle

Komal Khoja

Meta Tag

Author List Komal Khoja, Pinky Jha, Sarbagya Pandit, Trisha Jethwa

Category Clinical Vignettes

Concept Pneumomediastinum

Concept COVID-19 Pneumonia

Concept Macklin Effect

Concept Observation

Concept Alveolar Rupture

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Komal Khoja

Track Adult

Keywords

COVID-19 pneumonia

pneumomediastinum

subcutaneous emphysema

Macklin effect

CT angiography

conservative management

remdesivir

dexamethasone

ICU transfer

thoracic surgery

Pneumomediastinum

COVID-19 Pneumonia

Macklin Effect

Observation

Alveolar Rupture