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Medicine (Baltimore) SARS-CoV-2 Pneumonia With Subcutaneous Emphysema, Mediastinal Emphysema, and Pneumothorax: A Case Report

tetano

Editor, Senior Moderator
Medicine (Baltimore)


. 2020 May;99(20):e20208.
doi: 10.1097/MD.0000000000020208.
SARS-CoV-2 Pneumonia With Subcutaneous Emphysema, Mediastinal Emphysema, and Pneumothorax: A Case Report


Chunlin Xiang[SUP] 1 [/SUP], Gang Wu



Affiliations

Abstract

Introduction: Since the end of 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has affected more than 1,000,000 population in the world. Subcutaneous emphysema and pneumothorax are uncommon complications of SARS-CoV-2 pneumonia. Herein, we describe a fatal case of SARS-CoV-2 pneumonia with subcutaneous emphysema and pneumothorax.
Patient concerns: Subcutaneous emphysema was found in neck, bilateral chest walls, abdomen wall, groin area, and scrotum of a 67-year-old man. Extensive air-space opacities, subcutaneous emphysema and a small amount of pneumothorax were found in his chest X-ray scan. Echocardiography showed left ventricular enlargement with ejection fraction 20%.
Diagnosis: This resident of Wuhan with laboratory-confirmed SARS-CoV-2 infection had chronic pulmonary and cardiac diseases. Liver dysfunction, myocardial injury, and coagulation disorder were suggested by laboratory findings. Pneumonia, subcutaneous emphysema, and pneumothorax were confirmed with chest X-ray. Heart failure was revealed by echocardiography.
Interventions: He was transferred to intensive care unit, where invasive ventilation was used for him during the whole hospitalization. Prone position ventilation, vasoconstrictor, antibacteria, and antiviral therapy were given.
Outcomes: He died on the twelfth day after admission.
Conclusions: Subcutaneous emphysema and pneumothorax may occur in patients with SARS-CoV-2 pneumonia and chronic pulmonary disease. Chronic cardiac disease might be aggravated by SARS-CoV-2 infection, and develop heart failure.
 
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