University of Wisconsin–Madison Medical College of Wisconsin

Incidence and Prognosis of Pneumothorax and Pneumomediastinum in Hospitalized Patients With COVID-19 Pneumonia

Ahad Azeem, MD; Dua Noor Butt, MD; Margaret Carrig, BS; Bryan Krajicek, MD; Christopher Destache, Pharm D; Manasa Velagapudi, MBBS

WMJ. 2023;122(5):337-341

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Introduction: Coronavirus disease 2019 (COVID-19) can cause multisystem complications, with pulmonary involvement associated with the highest mortality. Pneumothorax (PT) and pneumomediastinum (PM) are uncommon complications of COVID-19 that have been reported to occur in the absence of trauma or mechanical ventilation. This study seeks to determine the incidence of these complications in patients with COVID-19 and evaluate clinical characteristics and outcomes.

Methods: We identified 3375 patients admitted to our health system during March 2020 through November 2020 who tested positive for SARS-CoV-2 with a polymerase chain reaction test. Patients were screened for PT or PM and were matched to COVID-19–positive patients without PT and/or PM. Data compared demographics, clinical characteristics, and laboratory values.

Results: Out of a total of 3375 COVID-19 admissions, 33 patients with PT/PM (1%) were compared to 32 matched controls without PT and/or PM. The patients with PT and/or PM demonstrated a significantly higher incidence of concomitant cancer diagnosis than those without PT and/or PM (18% vs 3%, respectively; P = 0.05). Those with PT and/or PM required significantly more invasive mechanical ventilation than those without PT and/or PM (79% vs 47%; P < 0.01). Mortality was significantly higher among those patients with PT and/or PM than those without PT/PM (55% vs 25%; P < 0.05).

Discussion: A significant number of COVID-19 patients with PT and/or PM had a concomitant cancer diagnosis, required supplemental oxygen on admission, and invasive mechanical ventilation during hospitalization. Additionally, the COVID patients with PT and/or PM had significantly higher mortality compared to those without PT and/or PM. However, with all retrospective studies, there are limitations.

Author Affiliations: Division of Infectious Disease, Creighton University School of Medicine, Omaha, Nebraska (Azeem, Velagapudi); Department of Internal Medicine, Creighton University School of Medicine, Omaha, Neb (Noor, Carrig); Division of Pulmonary, Critical Care and Sleep Medicine, Creighton University School of Medicine, Omaha, Neb (Krajicek); Creighton University School of Pharmacy and Health Professions, Omaha, Neb (Destache).
Corresponding Author: Dua Noor Butt, MD, 7500 Mercy Rd, Omaha, NE 68124; phone 402.978.0938; email
Funding/Support: None declared.
Financial Disclosures: None declared.
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