Prevalence of Pneumomediastinum and Pneumothorax in Patients with COVID-19: A Retrospective cross-sectional study from Pakistan
Abstract
Aim: To determine the prevalence of Pneumomediastinum and Pneumothorax in Patients with COVID-19.
Study design: Retrospective cross-sectional study
Place and duration: This study was conducted at Shaheed Muhatarma Benazir Bhutto Institute of Trauma (SMBBIT) Karachi, Pakistan from 1st April 2020 till 31st May 2021.
Methodology: The patients under observation were COVID positive and presented with non-iatrogenic pneumothorax (PTX)/ pneumomediastinum (PM). We collected all the information regarding the radiological characteristics, demographics, management, presentation, and outcome. Two groups were made: barotraumatic and spontaneous. T-test and Chi-square test were used to compare the two groups
Results: Forty-five out of 8209 COVID patients were diagnosed with PTX/PM. The incidence was calculated to be 0.54%. A total of 17 patients had barotrauma while 29 patients developed spontaneous PTX/PM. Diabetes-mellitus was the most frequently occurring comorbidity. The second most common comorbidity was hypertension. Large PTX was in most of the cases, that is 62.1%, and tension pneumothorax was in 27.5% of the cases. Subcutaneous emphysema was present in 37.7% of the cases. The mean (CTSS) CT severity score, was 15 whereas cystic-cavitary changes were present in 24% of cases. The CTSS for bronchiectatic changes was 16 (55%). Barotrauma and spontaneous cohort had very little statistical difference. Of the majority of cases that died, most of them were from the barotrauma cohort group.
Conclusion: It is very important to consider that PTX/PM could develop in patients that have COVID. It is very important to notice it in cases where the patient is deteriorating, regardless of whether they are breathing spontaneously or if they are mechanically ventilated. Patients that develop PTX/PM have a very high mortality rate. Hence, we know COVID-19 is extremely dangerous.
