Primary Spontaneous Pneumomediastinum and Extensive Cervical Emphysema in COVID-19 Infection: a Case Report

The coronavirus disease 2019 is a viral infection of the respiratory tract that can be complicated by the severe acute respiratory syndrome. The infection can be associated with atypical clinical manifestations and complications. We report the case of a 39-year-old man, non-smoker and with no past medical history, who was initially admitted to our department for a moderate COVID-19 pneumonia confirmed by detection of SARS-CoV-2 nucleic acid in nasopharyngeal swab using Real-Time Polymerase Chain Reaction. Sixty percent of lung parenchyma was affected in the thoracic CT-scan. Corticosteroids, antibiotic therapy, low molecular weight heparin and supportive oxygen therapy without mechanical ventilation were initiated. Four days after admission, the patient developed an extensive cervical anterior emphysema with pneumomediastinum. Surgical intervention was unnecessary. The patient was observed and his respiratory status improved slowly but continuously. The oxygen requirements decreased. Repeat CT-Scan showed a favourable outcome. This case brings attention to unusual possible complications of COVID-19.