Pneumomediastinum Associated with SARS-CoV-2 Infection: Risk Factors and Outcomes

Document Type

Conference Proceeding

Publication Date

10-22-2021

Publication Title

J Thorac Imaging

Abstract

Objectives: Pneumomediastinum has been noted as a rare complication of SARS-CoV-2 infection, increasingly seen in our institution. This study's purpose is to compare characteristics of COVID- 19 positive patients with pneumomediastinum to provide insight into risk factors and outcomes. Materials and Methods: COVID-19 patients with imaging-diagnosed spontaneous or post-intubation pneumomediastinum between 3/16/2020 and 5/15/2020 were compiled. The control group consisted of COVID-19 patients with thoracic imaging, without pneumomediastinum. Patient charts were retrospectively reviewed for demographics, past medical history, imaging findings, and outcome variables. Chi-squared and two-sample Wilcoxon tests were performed for nominal and continuous data, respectively. Results: Twenty-seven patients were positive for both COVID-19 and pneumomediastinum. 56% of these developed pneumomediastinum post-intubation. Longer mean lengths of stay (19.8 vs. 7.8 d, P<0.001) were found in those with pneumomediastinum versus those without; no significant difference in survival was found between groups. Those with spontaneous pneumomediastinum were more likely to have pulmonary embolism and pneumothorax (36.4% vs. 3.3%, P<0.002; 35.4% vs. 0.8%, P<0.001, respectively). Post-intubation pneumomediastinum patients were more likely to have pneumothorax and bronchiectasis (60% vs. 0%, P<0.001; 40% vs. 2.9%, P<0.038, respectively). Multivariate logistical regression demonstrated increasing likelihood of pneumomediastinum with decreasing BMI and age (OR 0.64, P<0.022; OR 0.54, P<0.012; respectively). Conclusions: Pneumomediastinum during admission for SARSCoV- 2 may result in increasing morbidity and longer admissions. Findings support studies showing increasing pneumomediastinum/ pneumothorax rates for younger and leaner patients. COVID- 19-related alveolar injury may make certain patients more susceptible to pneumomediastinum, specifically those with pulmonary embolism or chronic airway disease undergoing ventilation. COVID-19-related pneumomediastinum often presents with other features of barotrauma, rather than an isolated occurrence. Clinical Relevance Application: Identifying pneumomediastinum should be cause for radiologists to look for associated pneumothorax, especially in those not intubated. Clinicians should be aware of developing pneumomediastinum in those with pulmonary embolism or bronchiectasis, for targeted care, given the dependence on ventilator use for COVID-19 management.

Volume

36

Issue

6

First Page

W153

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