Pneumomediastinum in Severe COVID-19-disease: a Case Series of Eight Patients

The most common cause of pneumomediastinum is trauma. However, in the context of COVID-19 pneumonia, this clinical picture is more often found in patients without underlying exogenous injury. Pathophysiologically, a cause analogous to the Macklin effect is suspected here, in which tears at the alveolar level lead to emphysema along the tracheobronchial tree with concentrating in the mediastinum. Here we present a case series of eight patients who were treated in our intensive care unit. In all patients, mediastinal emphysema could already be seen in the chest X-ray. Five patients also received a computed tomography scan of the thorax. Six patients had invasive ventilation. All patients received corticosteroids, anticoagulation and antibiotics. Pleural drainage was applied only in patients with an additional pneumothorax (n = 5). Bronchoscopy was performed only if there was a suspicion of iatrogenic injury to the tracheobronchial tree in relation to the appearance of the pneumomediastinum (n = 2). Three patients died during intensive care as part of the COVID-19 disease. A prognostic relationship between the occurrence of a pneumomediastinum and a fatal course of the disease is discussed.