Pneumomediastinum, although a rare phenomenon, is more prevalent in patients with coronavirus disease 2019 (COVID-19) compared with historical patients with adult respiratory distress syndrome (ARDS), according to study results published in the Journal of Laparoendoscopic & Advanced Surgical Techniques.

Pneumomediastinum is a potentially life-threatening accumulation of air within the mediastinum that is associated with barotrauma, resulting in injury to the esophagus, trachea, lung, or pleural space. According to researchers, while pneumomediastinum has been reported to occur in up to 4% of patients with ARDS, data on the association between pneumomediastinum and COVID-19 are limited. Thus, the study authors sought to summarize the literature regarding pneumomediastinum in patients with COVID-19, and characterized the presentation and clinical outcomes of pneumomediastinum in patients with a proven diagnosis of COVID-19 and pneumomediastinum between March 18, 2020 and May 5, 2020 at a medical center in New York to better define the incidence, prognosis, and available treatment.

The researchers found that 36 patients with confirmed COVID-19 were diagnosed with pneumomediastinum. Of the 346 intubated patients with COVID-19, 34 (10%) had pneumomediastinum. The incidence of pneumomediastinum increased during the first 4 weeks of the pandemic and then began to decrease by week 5. By the end point of the study, of the patients who had pneumomediastinum and COVID-19, 6 (16.67%) of patients remained in the hospital, 6 (16.67%) patients were discharged, and 24 patients (66.7%) had died.

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“[Pneumomediastinum] associated with COVID-19 is relatively rare. However, it may be associated with increased mortality rate in critically ill intubated COVID-19 patients,” the study authors wrote. “Further studies are needed to better elucidate the risk factors associated with development of this complication and identify interventions to improve prognosis for patients with [pneumomediastinum] in the setting of COVID-19.”


Kangas-Dick A, Gazivoda V, Ibrahim M, et al. Pneumomediastinum in patients with COVID-19 pneumonia. J Laparoendosc Adv Surg Tech. Published online September 16, 2020. doi:10.1089/lap.2020.0692