Main Article Content
Abstract
Background. The incidence of subcutaneous emphysema in patients with severe pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus infection has been in the spotlight recently. Subcutaneous emphysema is a rare complication. With the increasing prevalence of subcutaneous emphysema in patients with confirmed coronavirus disease (COVID-19), it is necessary to know what factors can cause this and how to treat it.
Case Description. Two patients, a man and a woman aged 50 and 70 years, diagnosed with COVID-19, came to the Emergency Room (IGD) of Bunda Menteng General Hospital, Jakarta, with symptoms of acute respiratory distress syndrome (ARDS). Both patients experienced severe shortness of breath with a respiratory rate above 30 times per minute. Then the two patients were treated in the intensive care Unit (ICU) isolation room and required mechanical ventilation assistance. After 3-4 days of mechanical ventilation treatment, subcutaneous emphysema develops, characterized by subcutaneous crepitus. After chest x-rays were carried out in both patients, the results were subcutaneous emphysema and pneumomediastinum. Several invasive procedures have been performed, such as subcutaneous insertion of an intravenous cannula, mediastinoscopy, and chest tube insertion.
Conclusion. Complications of subcutaneous emphysema in COVID-19 patients are rare and require further research to determine the cause, where the infection is still the focus. With this case report, it is hoped that clinicians will pay more attention to the initial clinical findings of subcutaneous emphysema to reduce even more severe complications such as pneumothorax.
Keywords
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
- Cucinotta D,Vanelli M. WHO Declares COVID-19 a Pandemic. Acta Biomed. 2020;91(1):157-60. doi: 10.23750/abm.v91i1.9397.
- Komite Penanganan COVID-19 dan Pemulihan Ekonomi Nasional. Coronavirus disease 2019 (COVID-19) cases in Indonesia. [updated] 2021 May 6. [cited 2021 May 06]. Available from: URL: https://covid19.go.id/peta-sebaran.
- Wu J, Wu X, Zeng W, et al. Chest CT findings in patients with corona virus disease 2019 and its relationship with clinical features. Invest Radiol, 2020;55(5):257-61.doi: 10.1097/RLI.0000000000000670.
- Aghajanzadeh M, Dehnadi A, Ebrahimi H, et al. Classification and Management of Subcutaneous Emphysema: a 10-Year Experience. Indian J Surg. 2015;77(2):673-7. doi: 10.1007/s12262-013-0975-4.
- Kukuruza K, Aboeed A. Subcutaneous Emphysema. [updated] 2020 August 08. [cited 2021 May 06]. Available from: URL: https://www.ncbi.nlm.nih.gov/books/NBK542192/.
- Al-Azzawi M, Douedi S, Alshami A, et al. Spontaneous Subcutaneous Emphysema and Pneumomediastinum in COVID-19 Patients: An Indicator of Poor Prognosis?. The American journal of case reports. 2020;21:1-6. doi: 10.12659/AJCR.925557.
- Gahona CC, Raj K, Bhandari K,et al. Subcutaneous Emphysema in Patients With COVID-19 Infection: A Report of Three Cases. Cureus. 2020;12(9): e10559. doi: 10.7759/cureus.10559.
- Agrawal A, Sen KK, Satapathy G,et al. Spontaneous pneumomediastinum, pneumothorax and subcutaneous emphysema in COVID-19 patients a case series. Egypt J Radiol Nucl Med. 2021;52(27). doi: https://doi.org/10.1186/s43055-020-00401-0.
- Sun R, Liu H, Wang X. Mediastinal emphysema, giant bulla, and pneumothorax developed during the course of COVID-19 pneumonia. Korean J Radiol. 2020;21(5): 541–4. doi: 10.3348/kjr.2020.0180 .
- Lemmers DHL, Hilal M, Bnà C, et al, Pneumomediastinum and subcutaneous emphysema in COVID-19: barotrauma or lung frailty? . ERJ Open Research. 2020;6(4): 00385-2020. doi: 10.1183/23120541.00385-2020 .
- Sami R, Sereshti N. Case Report: Barotrauma in COVID-19 Case Series. The American Journal of Tropical Medicine and Hygiene. 2021;105(1):54-8. doi: https://doi.org/10.4269/ajtmh.21-0080.
- Hsu CW, Sun SF. Iatrogenic pneumothorax related to mechanical ventilation. World J Crit Care Med. 2014;3(1):8-14. doi: 10.5492/wjccm.v3.i1.8.
- Jo YY, Park WY, Koo BN, et al. Delayed detection of subcutaneous emphysema following routine endotracheal intubation -A case report. Korean J Anesthesiol. 2010;59(3): 220–3. doi: 10.4097/kjae.2010.59.3.220.
- Diaz R, Heller D. Barotrauma And Mechanical Ventilation. [updated] 2020 August 8]. [cited 2021 May 06]. Available from: URL: Available from: https://www.ncbi.nlm.nih.gov/books/NBK545226/.
- Sethi SM, Ahmed AS, Hanif S, et.al. Subcutaneous emphysema and pneumomediastinum in patients with COVID-19 disease; case series from a tertiary care hospital in Pakistan. Epidemiol Infect. 2021;149:e37. doi: 10.1017/S095026882100011X.
- Fan E, Del Sorbo L, Goligher EC, et al. An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: mechanical ventilation in adult patients with acute respiratory distress syndrome. Am J Respir Crit Care Med. 2017;195: 1253–63. doi:10.1164/rccm.201703-0548ST.
References
Cucinotta D,Vanelli M. WHO Declares COVID-19 a Pandemic. Acta Biomed. 2020;91(1):157-60. doi: 10.23750/abm.v91i1.9397.
Komite Penanganan COVID-19 dan Pemulihan Ekonomi Nasional. Coronavirus disease 2019 (COVID-19) cases in Indonesia. [updated] 2021 May 6. [cited 2021 May 06]. Available from: URL: https://covid19.go.id/peta-sebaran.
Wu J, Wu X, Zeng W, et al. Chest CT findings in patients with corona virus disease 2019 and its relationship with clinical features. Invest Radiol, 2020;55(5):257-61.doi: 10.1097/RLI.0000000000000670.
Aghajanzadeh M, Dehnadi A, Ebrahimi H, et al. Classification and Management of Subcutaneous Emphysema: a 10-Year Experience. Indian J Surg. 2015;77(2):673-7. doi: 10.1007/s12262-013-0975-4.
Kukuruza K, Aboeed A. Subcutaneous Emphysema. [updated] 2020 August 08. [cited 2021 May 06]. Available from: URL: https://www.ncbi.nlm.nih.gov/books/NBK542192/.
Al-Azzawi M, Douedi S, Alshami A, et al. Spontaneous Subcutaneous Emphysema and Pneumomediastinum in COVID-19 Patients: An Indicator of Poor Prognosis?. The American journal of case reports. 2020;21:1-6. doi: 10.12659/AJCR.925557.
Gahona CC, Raj K, Bhandari K,et al. Subcutaneous Emphysema in Patients With COVID-19 Infection: A Report of Three Cases. Cureus. 2020;12(9): e10559. doi: 10.7759/cureus.10559.
Agrawal A, Sen KK, Satapathy G,et al. Spontaneous pneumomediastinum, pneumothorax and subcutaneous emphysema in COVID-19 patients a case series. Egypt J Radiol Nucl Med. 2021;52(27). doi: https://doi.org/10.1186/s43055-020-00401-0.
Sun R, Liu H, Wang X. Mediastinal emphysema, giant bulla, and pneumothorax developed during the course of COVID-19 pneumonia. Korean J Radiol. 2020;21(5): 541–4. doi: 10.3348/kjr.2020.0180 .
Lemmers DHL, Hilal M, Bnà C, et al, Pneumomediastinum and subcutaneous emphysema in COVID-19: barotrauma or lung frailty? . ERJ Open Research. 2020;6(4): 00385-2020. doi: 10.1183/23120541.00385-2020 .
Sami R, Sereshti N. Case Report: Barotrauma in COVID-19 Case Series. The American Journal of Tropical Medicine and Hygiene. 2021;105(1):54-8. doi: https://doi.org/10.4269/ajtmh.21-0080.
Hsu CW, Sun SF. Iatrogenic pneumothorax related to mechanical ventilation. World J Crit Care Med. 2014;3(1):8-14. doi: 10.5492/wjccm.v3.i1.8.
Jo YY, Park WY, Koo BN, et al. Delayed detection of subcutaneous emphysema following routine endotracheal intubation -A case report. Korean J Anesthesiol. 2010;59(3): 220–3. doi: 10.4097/kjae.2010.59.3.220.
Diaz R, Heller D. Barotrauma And Mechanical Ventilation. [updated] 2020 August 8]. [cited 2021 May 06]. Available from: URL: Available from: https://www.ncbi.nlm.nih.gov/books/NBK545226/.
Sethi SM, Ahmed AS, Hanif S, et.al. Subcutaneous emphysema and pneumomediastinum in patients with COVID-19 disease; case series from a tertiary care hospital in Pakistan. Epidemiol Infect. 2021;149:e37. doi: 10.1017/S095026882100011X.
Fan E, Del Sorbo L, Goligher EC, et al. An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: mechanical ventilation in adult patients with acute respiratory distress syndrome. Am J Respir Crit Care Med. 2017;195: 1253–63. doi:10.1164/rccm.201703-0548ST.