Atipik Bir Covid-19 Olgusu; Spontan Subkutan Amfizem ve Spontan Pnömomediastinum

Yıl 2021, Cilt: 4 Sayı: 2, 65 - 67, 29.06.2021

Agit Akgül , Sevilay Sema Ünver , Tuğçe Burnaz

Öz

Amaç: Covid-19 pandemisi dünyayı sarsan yeni bir hastalıktır. Keskin sınırlandırılamayan farklı klinik tabloları
hastalığın patogenezini aydınlatmaya ve yeni tedavi çalışmalarına yol gösterebilir. Biz nadir rastlanan spontan pnömomediastinum ve subkutan amfizem mevcut olan bir Covid-19 hastasını sunmayı amaçladık.

Olgu: 40 yaşında erkek hasta solunum güçlüğü şikayetiyle hastanemize başvurdu. Gelişinde siyanoze, bilinci konfüze, soğuk terliydi. Vital bulguları; kan basıncı:145/85, nabız:142, solunum sayısı:40, ateş:37.8 desteksiz oksijen saturasyonu:65 şeklindeydi. Boyun her iki yanında palpasyonla krepitasyon mevcuttu. Hastanın bilgisayarlı tomografi görüntülemesinde; periferik yerleşimli buzlu cam görüntülerine eşlik eden subkutan amfizem ve pnömomediastinum mevcuttu. Solunum güçlüğü devam eden hasta entübe edilerek yoğun bakım birimine alındı. Yoğun bakım tedavisinin ikinci gününde kardiyopulmoner arrest gelişen hasta exitus kabul edildi.

Sonuç: Covid-19 genç hastalarda da mortaliteye sebep olmaktadır. Covid-19 farklı klinik tablolar içerebilmektedir. Pandemi biriminde görevli hekimler atipik başvurulara hazırlıklı olmalı; farklı muayene bulguları Covid-19 açısından akılda tutulmalıdır.

Anahtar Kelimeler

Covid-19, pnömomediastinum, subkütanöz amfizem

An Atypical Covid-19 Case; Spontaneous Subcutaneous Emphysema and Spontaneous Pneumomediastinum

Öz

Aim: Covid-19 pandemic is a new disease that shook the world. Its distinct clinical pictures that cannot be sharply limited may illuminate the pathogenesis of the disease and lead to new treatment studies. We aimed to present a Covid- 19 patient with rare spontaneous pneumomediastinum and subcutaneous emphysema.

Case: A 40-year-old male patient was admitted to our hospital with respiratory distress. On his arrival he was cyanotic, confused, cold sweaty. Vital signs; blood pressure: 145/85 pulse: 142 respiratory rate: 40 fever: 37.8 unsupported oxygen saturation: 65. There was crepitation with palpation on both sides of the neck. In the computed tomography imaging of the patient; There were subcutaneous emphysema and pneumomediastinum accompanying peripherally located ground glass images. The patient whose respiratory distress persisted was intubated and taken to the intensive care unit. The patient who developed cardiopulmonary arrest on the second day of intensive care treatment was accepted as exitus.

Conclusion: Covid-19 also causes mortality in young patients. Covid-19 can contain different clinical pictures. Physicians working in the pandemic unit should be prepared for atypical applications; different examination findings should be kept in mind in terms of Covid-19.

Anahtar Kelimeler

Covid-19, spontaneous subcutanous emphysema, spontaneous pneumomediastinum

Kaynakça

• Zhou C, Gao C, Xie Y, et al. COVID-19 with spontaneous pneumomediastinum. Lancet Infect Dis 2020:S10.
• Quincho-Lopez A, Quincho-Lopez DL, Hurtado-Medina FD. Case Report: Pneumothorax and Pneumomediastinum as Uncommon Complications of COVID-19 Pneumonia-Literature Review. Am J Trop Med Hyg. 2020;103(3):1170-1176. doi:10.4269/ajtmh.20-0815
• Cools B, Plaskie K, Van de Vijver K, et al. Unsuccessful resuscitation of a preterm infant due to a pneumothorax and a masked tension pneumopericardium. Resuscitation 2008; 78: 236-239 [PMID: 18485563 DOI: 10.1016/j.resuscitation.2008.02.025]
• Macia I, Moya J, Ramos R, et al. Spontaneous pneumomediastinum: 41 cases. Eur J Cardiothorac Surg 2007; 31: 1110-1114 [PMID: 17420139 DOI: 10.1016/j.ejcts.2007.03.008]
• Dionísio, P, Martins, L, Moreira, S, et al. Spontaneous pneumomediastinum: experience in 18 patients during the last 12 years. J Bras Pneumol 2017; 43(2): 101–105.
• Kolani, S, Houari, N, Haloua, M, et al. Spontaneous pneumomediastinum occurring in the SARS-COV-2 infection. IDCases 2020; 21: e00806
• Gralinski, LE, Baric, RS. Molecular pathology of emerging coronavirus infections. J Pathol 2015; 235(2): 185–195.