Imaging in the COVID-19 era: Lessons learned during a pandemic

Figure 2  Barotrauma. A and B: Coronal (A) and axial (B) images from an unenhanced computed tomography of the chest of a 75-yr-old male with no significant past medical history, who was intubated for acute hypoxic respiratory failure secondary to coronavirus disease 2019 pneumonia. There are ground glass opacities anteriorly, as well as consolidations with air bronchograms posteriorly, a pattern typical for acute respiratory distress syndrome. There is a massive amount of air within the mediastinum resulting from alveolar rupture (Macklin effect). The arrow on image (A) points to interstitial emphysema, surrounding a pulmonary vein. The arrow on image (B) points to nonanatomic air within a pulmonary lobule, which may represent the initial barotrauma event. There is extensive soft tissue emphysema in the lower neck and lateral chest wall, as well as in the extraperitoneal space of the abdominal cavity. Bilateral thoracostomy tubes and a peripherally-inserted central catheter are in place. The patient could not be weaned from ventilation and subsequently expired.