Published: 2021-08-27

Conservative management of subcutaneous emphysema and pneumomediastinum in a COVID-19 viral pneumonia patient-case report

Krishna Ramavath, Sidharth S. Rao, Nyna Sindhu, Satish S. Nagaraj, Pranay Palle


In viral pneumonia, the incidence of subcutaneous emphysema and spontaneous pneumomediastinum are rare. But it can occur due to COVID-19 SARS (severe acute respiratory syndrome) corona infection. In this condition like COVID-19 disease the underlying pathology may be due to diffuse alveolar injury. High pressure levels in the alveoli can cause to the alveoli to rupture and ultimately to forms subcutaneous emphysema. We report one case of COVID-19 admitted in the hospital and later developed subcutaneous emphysema and pneumomediastinum without mechanical ventilation. He was managed conservatively without any intervention. 45 old male without co morbidities having post COVID-19 subcutaneous emphysema and pneumomediastinum developed without mechanical ventilation and he was managed conservatively without any surgical intervention. In COVID-19 viral pneumonia patients can develop subcutaneous emphysema without mechanical ventilation and should be careful for severe pneumomediastinum which can cause death. It can be managed conservatively in hemodynamic stable condition


COVID-19, Subcutaneous emphysema, Pneumomediastinum, SARS-corona virus

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Chen N, Zhou M, Dong X. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395:503-17.

Xu Z, Shi L, Wang Y. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020;8:420-2.

Wang J, Su X, Zhang T. Spontaneous pneumomediastinum: a probable unusual complication of coronavirus disease 2019(COVID-19) pneumonia. Korean J Radiol. 2020;21:627-8.

ZhouC, Gao C, Xie Y. COVID-19 with spontaneous pneumomediastinum. Lancet Infect Dis. 2020:S10.

Sun R, Liu H, Wang X. Mediastinal emphysema, giant bulla, and pneumothorax developed during the course of COVID-19 pneumonia. Korean J Radiol. 2020;21:541-4.

Maunder RJ.Subcutaneous and mediastinal emphysema. Pathophysiology, diagnosis, and management. Arch Intern Med. 1984;144:1447-53.

Wintermark M, Schnyder P. The Macklin effect: a frequent etiology for pneumomediastinum in severe blunt chest trauma. Chest. 2001;120(2):543-7.

Anzueto A, Frutos-Vivar F, Esteban A, et al. Incidence, risk factors and outcome of barotrauma in mechanically ventilated patients. Intensive Care Med. 2004;30:612-9.

Sonobe S, Inoue S, Nishiwada T. A case of subcutaneous emphysema/mediastinal emphysema during the use of humidified high-flow nasal cannula. J Clin Rep. 2019;45:50-9.

Koullias GJ, Korkolis DP, Wang XJ. Current assessment and management of spontaneous pneumomediastinum: experience in 24 adult patients. Eur J Cardiothorac Surg. 2004;25(5):852-5.

Chung M, Bernheim A, Mei X. CT imaging features of 2019 novel coronavirus (2019-nCoV). Radiology. 2020;295(1):202-7.