Tension Pneumomediastinum in a COVID-19 Patient.

A 60-year-old man with COVID-19 was mechanically ventilated for 32 days before his condition abruptly worsened with hemodynamic collapse: tachycardia (124 beats/min), hypotension (90/50 mm Hg), distended neck veins, and muffled heart sounds (Beck’s triad). Computed tomography (CT) demonstrated tension pneumomediastinum with compressed cardiac chambers simulating acute cardiac tamponade (Fig 1 ). The patient was transported to a negative pressure interventional suite with a CT scanner. CT-guided drainage was performed using the trocar method via the anterior fourth intercostal space and a Wayne Pneumothorax Catheter (Cook Medical, Bloomington, Indiana) advanced posterosuperiorly, preattached to a closed drainage system to prevent aerosolization, with audible gas escape into the system, followed by immediate circulatory recovery. CT after drainage demonstrated the restoration of heart volume (Fig 2 ). High-pressure invasive ventilation, frequently required for severe COVID-19, may predispose to pneumomediastinum, which should be included in the differential diagnosis of such patients when presenting with hemodynamic deterioration.

Figure 1

Computed tomography demonstrated tension pneumomediastinum with compressed cardiac chambers.

Figure 2

Postprocedure computed tomography demonstrated decreased pneumomediastinum and restored heart volume.