Rare Complications of COVID-19 Pneumonia: Pneumomediastinum and Atrial Fibrillation

Year 2021, Volume: 13 Issue: 3, 652 - 656, 18.10.2021

Şeyma Tunç , Pınar Yıldız Gülhan , Mertay Boran

https://doi.org/10.18521/ktd.912819

Abstract

Objective: Coronavirus disease 2019(COVID-19) is considered as systemic disease involving many vital organs in addition to the lungs, including the heart, liver, and kidneys. Pneumomediastinum associated with COVID-19 pneumonia is a rare condition usually seen in patients with underlying lung pathology, infections, or mechanical intubation. We presented a case of late diagnosis of pneumomediastinum and atrial fibrillation in COVID-19 patient undergoing Noninvasive mechanical ventilation (NIMV).
Case: A 66-year-old male patient with a history of COVID-19 pneumonia and 19 days hospital follow up and a NIMV treatment was admitted to our emergency department with palpitations and dyspnea. Thoracic CT and electrocardiography revealed, scattered ground glass areas, pneumomediastinum and high-velocity atrial fibrillation, respectively.
Conclusion: We recommend regular checks with imaging methods and ECG during follow-up in patients with COVID-19. Clinicians should remember that ventilator-related lung damage may be seen in COVID-19 patients undergoing NIMV.

Keywords

COVID-19, pneumomediastinum, positive pressure ventilation, atrial fibrillation

COVID-19 Pnömonisinin Nadir Komplikasyonları: Pnömomediastinum ve Atriyal Fibrilasyon

Abstract

Giriş: Koronavirüs hastalığı 2019 (COVID–19), akciğerlere ek olarak kalp, karaciğer ve böbrekler dahil olmak üzere birçok hayati organı içeren sistemik bir hastalık olarak kabul edilir. COVID–19 pnömonisi ile ilişkili pnömomediastinum, genellikle altta yatan akciğer patolojisi, enfeksiyonları veya mekanik entübasyonu olan hastalarda görülen nadir bir durumdur. Burada, noninvazif mekanik ventilasyon (NIMV) uygulanan COVID–19 hastasında geç tanı konulan bir pnömomediastinum ve atriyal fibrilasyon olgusunu sunduk.
Olgu: COVID–19 pnömonisi için 19 gün hastane takibi ve NIMV tedavisi öyküsü olan 66 yaşında erkek hasta, acil servisimize çarpıntı ve nefes darlığı şikayeti ile başvurdu. Torasik BT ve elektrokardiyografide sırasıyla dağınık buzlu cam alanları, pnömomediastinum ve yüksek hızlı atriyal fibrilasyon saptandı.
Sonuç: COVID–19 hastalarında takip sırasında görüntüleme yöntemleri ve elektrokardiyografi ile düzenli kontroller yapılmasını öneriyoruz. Klinisyenler, NIMV uygulanan COVID–19 hastalarında vantilatöre bağlı akciğer hasarının görülebileceğini akılda tutmalıdır.

Keywords

COVID-19, Pnömomediastinum, Pozitif basınçlı ventilasyon, Atrial fibrilasyon

References

• REFERENCES 1) H Shi, X Han, N Jiang, Cao Y, Alwalid O, Gu j, et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis 2020; 20 (4): 425-434.
• 2) Urigo C, Soin S, Sahu A. Spontaneous pneumomediastinum as a complication of a COVID-19 related pneumonia: case report and review of literature. Radiology Case Reports 2020; 15(12): 2577–2581.
• 3) Chen N, Zhou M, Dong X, Qu j, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395(10223):507-513.
• 4) Elhakim TS, Abdul HS, Romero CP, Rodriguez-Fuentes Y. Spontaneous pneumomediastinum, pneumothorax and subcutaneous emphysema in COVİD-19 pneumonia: a rare case and literature review. BMJ Case Report 2020; 13:e239489. doi: 10.1136/bcr-2020- 239489
• 5) Mohan V, Taussen RA. Spontaneous pneumomediastinum in COVID-19. BMJ Case Reports 2020; 13: e236519. doi: 10.1136/bcr-2020-236519
• 6) Jougon JB, Ballester M, Delcambre F, Mac Bride T, Dromer CEH, Velly JF. Assesment of spontaneous pneumomediastinum: Experience with 12 patients. Ann Thorac Surg 2003; 75(6):1711-4
• 7) Sahni S, Verma S, Grullon J, Esquire A, Patel P, Talwar A. Spontaneous Pneumomediastinum: Time for Consensus. North American Journal of Medical Sciences 2013; 5 (8), 460-464
• 8) Macklin MT, Macklin CC. Malignant interstitial emphysema of the lungs and mediastinum as an important occult complication in many respiratory diseases and other conditions: an interpretation of the clinical literature in the light of laboratory experiment. Medicine (Baltimore) 1944; 23: 281-358.
• 9) Kouritas VK, Papagiannopoulos K, Lazaridis G, Baka S, Mpoukovinas I, Karavasilis V, et al. Pneumomediastinum. J Thorac Dis 2015; 7(2): 44-9.
• 10) Xx Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVİD-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020; 8(4): 420-422.
• 11) McGuiness G, Zhan C, Rosenberg N, Amour L, Wickstrom M, Mason DM, et al. High Incidence of Barotrauma in Patients with COVID-19 Infection on Invasive Mechanical Ventilation. Radiological Society Health Emergency Collection 2020, 2 : 202352, doi: 10.1148/radiol.2020202352
• 12) Kuipers S, Klouwenberg PMK, Cremer OL. Incidence, risk factors and outcomes of new-onset atrial fibrillation in patients with sepsis: a systematic review. Crit Care. 2014; 18(6): 688. doi: 10.1186/s13054-014-0688-5
• 13) Gopinathannair R, Merchant FM, Lakkireddy DR, Etheridge SP, Feigofsky S, Han JK, et al. COVID-19 and cardiac arrhythmias: a global perspective on arrhythmia characteristics and management strategies. J Interv Card Electrophysiol 2020: 1-8. doi: 10.1007/s10840-020-00789-9
• 14) Colon CM, Barrios JG, Chiles JW, McElwee SK, Russell DW, Maddox WR, Kay GN. Atrial arrhytmias in COVID-19 patients. JACC: Clin Electtrophysiol. 2020; 6(9): 1189–1190.