Simultaneous Occurrence of Pneumomediastinum, Pneumopericardium and Surgical Emphysema in a Patient of COVID-19: A Case Report

As we enter the third year of the COVID pandemic, the SARS-CoV-2 virus keeps on surprising clinicians globally with atypical manifestations. Spontaneous pneumomediastinum is the accumulation of free air within the mediastinum without any preceding trauma or invasive procedure. Pneumomediastinum has been recently reported in the literature, often with associated mortality and morbidity in COVID-19 patients exposed to positive pressure ventilation due to barotrauma. We report the case of a 47-year-old man admitted for management of infection by the SARS-CoV-2. After one week of in-patient treatment, the patient still had worsening dyspnea. Repeat chest X-ray revealed surgical emphysema in neck and NCCT chest revealed pneumomediastinum and pneumopericardium. The spontaneous pneumomediastinum and pneumopericardium with surgical emphysema resorbed over 22 days with a favourable clinical outcome without any invasive intervention. Patient was discharged subsequently with vitals maintaining on room air. A keen clinical observation and timely imaging study can help in detecting these complications early and direct the management accordingly.