ARRS 2022 Abstracts

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E1034. Don’t Skip a Beat: Spotting Spontaneous Pneumomediastinum in COVID-19 Patients
Authors
  1. Iris Chen; UCLA
  2. Antoinette Roth; Olive View - UCLA Medical Center
  3. Mariam Thomas; Olive View - UCLA Medical Center
  4. Anokh Pahwa; Olive View - UCLA Medical Center
Background
Isolated spontaneous pneumomediastinum (SPM) is defined as air within the mediastinal space and is typically seen in the context of trauma, esophageal perforation, smoking, lung disease, and positive pressure from mechanical ventilation. Increased use of high-flow oxygen in COVID-19 management may be a potential contributing factor to the development of isolated SPM. Recognizing this important finding on imaging is essential to timely and efficient patient care.

Educational Goals / Teaching Points
This exhibit will review the clinical presentation, radiograph, and CT imaging features, and hospital course of isolated SPM in several patients hospitalized with COVID-19 who were not on mechanical ventilation. We will discuss the risk factors, clinical manifestations, management, and prognosis of isolated SPM in patients with COVID-19. Lastly, we will include illustrative cases and interactive quiz questions.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The mechanism for SPM is thought to be related to alveolar rupture and interstitial emphysema from diffuse alveolar damage, causing extrapulmonary air to dissect along the perivascular and peribronchial connective tissue sheaths into the mediastinum, described as the Macklin effect. Clinical manifestations of SPM can include retrosternal chest pain exacerbated by deep breathing and coughing, progressive dyspnea, dysphagia, or neck pain, although the patient may also be asymptomatic. SPM can be best visualized on imaging on chest CT; it can be seen on chest radiograph with lower sensitivity as well. Management for isolated SPM is nonspecific and generally involves symptomatic treatment, oxygen therapy, and continued treatment for COVID-19. Isolated SPM may portend a worse prognosis in patients hospitalized with COVID-19.

Conclusion
Isolated SPM is an infrequent but possibly fatal complication and may be a sign of worse prognosis in patients with COVID-19 without history of mechanical ventilation or positive airway pressure support. Recognition of isolated SPM involves close clinical and imaging monitoring of patients.