Incidence and Prognosis of Pneumothorax and Pneumomediastinum in Hospitalized Patients With COVID-19 Pneumonia.

INTRODUCTION:Coronavirus disease 2019 (COVID-19) can cause multisystem complications, with pulmonary involvement associated with the highest mortality. Pneumothorax (PT) and pneumomediastinum (PM) are uncommon complications of COVID-19 that have been reported to occur in the absence of trauma or mechanical ventilation. This study seeks to determine the incidence of these complications in patients with COVID-19 and evaluate clinical characteristics and outcomes. METHODS:We identified 3375 patients admitted to our health system during March 2020 through November 2020 who tested positive for SARS-CoV-2 with a polymerase chain reaction test. Patients were screened for PT or PM and were matched to COVID-19-positive patients without PT and/or PM. Data compared demographics, clinical characteristics, and laboratory values. RESULTS:Out of a total of 3375 COVID-19 admissions, 33 patients with PT/PM (1%) were compared to 32 matched controls without PT and/or PM. The patients with PT and/or PM demonstrated a significantly higher incidence of concomitant cancer diagnosis than those without PT and/or PM (18% vs 3%, respectively; P = 0.05). Those with PT and/or PM required significantly more invasive mechanical ventilation than those without PT and/or PM (79% vs 47%; P < 0.01). Mortality was significantly higher among those patients with PT and/or PM than those without PT/PM (55% vs 25%; P < 0.05). DISCUSSION:A significant number of COVID-19 patients with PT and/or PM had a concomitant cancer diagnosis, required supplemental oxygen on admission, and invasive mechanical ventilation during hospitalization. Additionally, the COVID patients with PT and/or PM had significantly higher mortality compared to those without PT and/or PM. However, with all retrospective studies, there are limitations.