Subcutaneous Emphysema and Pneumomediastinum Following Non-invasive Ventilation in a Patient With Severe COVID-19 Disease

Subcutaneous emphysema (SE) and pneumomediastinum are rare complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). While SE is often non-fatal and usually self-remitting, pneumomediastinum can be fatal with high mortality rates depending on the underlying etiology. Here, we present the case of a 39-year-old otherwise healthy male who tested positive for SARS-CoV-2. The patient was treated with non-invasive mechanical ventilation (NIMV) and developed severe SE and pneumomediastinum which resulted in a fatal outcome. Although the exact pathogenesis could not be determined, the extensive lung injury caused by SARS-CoV-2 pneumonia along with possible barotrauma secondary to NIMV could have been the culprits in this case. Early detection through careful observation of these potentially fatal complications in patients with severe coronavirus disease 2019 is crucial. Further studies determining the potential risk factors and incidence of SE and pneumomediastinum, especially in patients receiving invasive mechanical ventilation or NIMV, are needed.