Rare Complication of Pneumomediastinum and Pneumopericardium
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A 33-year-old Hispanic male with no known chronic health issues presented with complaints of subjective fever, body aches, worsening shortness of breath, cough, and headache for 13 days. He also complained of sharp retrosternal chest pain. Social history was consistent with occasional alcohol consumption, lifelong nonsmoker.

On presentation, his oral temperature was 39.5 C, heart rate 80/min, respiratory rate 26/min with an oxygen saturation of 96% on room air, and blood pressure 113/74?mmHg. Physical examination was notable for tachypnea with clear lungs on auscultation and no visible signs of respiratory distress. He was positive for SARS-CoV-2 based on RT-PCR analysis of nasopharyngeal swab. Arterial blood gas on room air showed hypoxia with pO2 68, pCO2 42, and pH?7.4. Faint patchy infiltrates in both lungs were seen on a portable chest X-ray. On chest CT, multiple confluent areas of ground-glass opacification and alveolar consolidation were present throughout the peripheries of both lungs. There was no evidence of pulmonary embolism; however, pneumomediastinum and pneumopericardium were noted.

The patient had a hospital course (with appropriate droplet and contact precautions) of six days requiring 3?L supplemental oxygen via nasal cannula to maintain oxygen saturation between 88-92%.

Patient received oral azithromycin for five days, and in the absence of severely elevated inflammatory markers and cytokine storm, the need for dexamethasone or tocilizumab was not felt. He was weaned off the supplemental oxygen successfully. Shortness of breath, chest pain, and cough were resolved on day 3. His temperature on the day of discharge was 36.8 C, heart rate 63/min and respiratory rate 16/min, and was saturating at O2 94% on room air. Repeat chest CT showed decreasing pneumomediastinum and persistent bilateral consolidation. He was discharged home with advice to follow-up with the pulmonology clinic in the outpatient setting.

Source: https://www.hindawi.com/journals/cripu/2020/8845256/