Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2020; 8(16): 3573-3577
Published online Aug 26, 2020. doi: 10.12998/wjcc.v8.i16.3573
Spontaneous pneumomediastinum in an elderly COVID-19 patient: A case report
Ning Kong, Chen Gao, Mao-Sheng Xu, Yuan-Liang Xie, Chang-Yu Zhou
Ning Kong, Department of Radiology, The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
Chen Gao, Mao-Sheng Xu, Chang-Yu Zhou, Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
Yuan-Liang Xie, Department of Radiology, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, Hubei Province, China
Author contributions: Kong N drafted the manuscript; Gao C performed the literature search; Xu MS interpreted the data; Zhou CY and Xie YL designed the study and reviewed the final manuscript; all authors have read and approved the final manuscript.
Supported by the Zhejiang Provincial Natural Science Foundation of China, No. LSY19H180003.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Chang-Yu Zhou, MD, Doctor, Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, No. 54 Youdian Road, Hangzhou 310006, Zhejiang Province, China. tophorizon@zcmu.edu.cn
Received: May 28, 2020
Peer-review started: May 28, 2020
First decision: July 3, 2020
Revised: July 16, 2020
Accepted: August 1, 2020
Article in press: August 1, 2020
Published online: August 26, 2020
Processing time: 88 Days and 20.5 Hours
Abstract
BACKGROUND

Spontaneous pneumomediastinum (SPM) is more common in young adults, usually caused by external factors like trauma. It causes symptoms such as chest pain or dyspnea, but it is rare to see elderly patients who develop SPM. Here we report the case of an elderly patient diagnosed with coronavirus disease 2019 (COVID-19) who neither got mechanical ventilation nor had chest trauma but were found to develop SPM for unknown reason.

CASE SUMMARY

A 62-year-old man complained of a 14-d history of fever accompanied by dry cough, shortness of breath, wheezing, myalgia, nausea, and vomiting. Real-time fluorescence polymerase chain reaction confirmed the diagnosis of COVID-19. The patient was treated with supplementary oxygen by nasal cannula and gamma globulin. Other symptomatic treatments included antibacterial and antiviral treatments. On day 4 of hospitalization, he reported sudden onset of dyspnea. On day 6, he was somnolent. On day 12, the patient reported worsening right-sided chest pain which eventually progressed to bilateral chest pain. He was diagnosed with SPM, with no clear trigger found. Conservative treatment was administrated. During follow-up, the pneumomediastinum had resolved and the patient recovered without other complications.

CONCLUSION

We presume that aging lung changes and bronchopulmonary infection play an important part in the onset of SPM in COVID-19, but severe acute respiratory syndrome may represent a separate pathophysiologic mechanism for pneumomediastinum. Although the incidence of SPM in elderly patients is low, clinicians should be alert to the possibility of SPM in those infected with severe acute respiratory syndrome coronavirus 2 for life-threatening complications such as cardiorespiratory arrest may occur.

Keywords: Aging; Spontaneous pneumomediastinum; COVID-19; SARS; Case report

Core tip: The occurrence of spontaneous pneumomediastinum in coronavirus disease 2019 patients shows an ominous sign and should be taken into consideration even the patient’s age does not fit the stereotype of pneumomediastinum patients. The aging lung changes and bronchopulmonary infection can be the causes.