{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T04:23:23Z","timestamp":1770351803940,"version":"3.49.0"},"reference-count":15,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2022,10,26]],"date-time":"2022-10-26T00:00:00Z","timestamp":1666742400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>For COVID-19 pneumonia, many manifestations such as fever, dyspnea, dry cough, anosmia and tiredness have been described, but differences have been observed from person to person according to age, pulmonary function, damage and severity. In clinical practice, it has been found that patients with severe forms of infection with COVID-19 develop serious complications, including pneumomediastinum. Although two years have passed since the beginning of the pandemic with the SARS-CoV-2 virus and progress has been made in understanding the pathophysiological mechanisms underlying the COVID-19 infection, there are also unknown factors that contribute to the evolution of the disease and can lead to the emergence some complications. In this case report, we present a patient with COVID-19 infection who developed a massive spontaneous pneumomediastinum and subcutaneous emphysema during hospitalization, with no pre-existing lung pathology and no history of smoking. The patient did not get mechanical ventilation or chest trauma, but the possible cause could be severe alveolar inflammation. The CT results highlighted pneumonia in context with SARS-CoV-2 infection affecting about 50% of the pulmonary area. During hospitalization, lung lesions evolved 80% pulmonary damage associated with pneumomediastinum and subcutaneous emphysema. After three months, the patient completely recovered and the pneumomediastinum fully recovered with the complete disappearance of the lesions. Pneumomediastinum is a severe and rare complication in COVID-19 pneumonia, especially in male patients, without risk factors, and an early diagnosis can increase the chances of survival.<\/jats:p>","DOI":"10.3390\/medicina58111525","type":"journal-article","created":{"date-parts":[[2022,10,26]],"date-time":"2022-10-26T07:17:48Z","timestamp":1666768668000},"page":"1525","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Massive Spontaneous Pneumomediastinum\u2014A Form of Presentation for Severe COVID-19 Pneumonia"],"prefix":"10.3390","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7573-3714","authenticated-orcid":false,"given":"Camelia Corina","family":"Pescaru","sequence":"first","affiliation":[{"name":"Pulmonology Department, \u2018Victor Babes\u2019 University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), \u2018Victor Babes\u2019 University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1160-9164","authenticated-orcid":false,"given":"Monica Stelu\u021ba","family":"Marc","sequence":"additional","affiliation":[{"name":"Pulmonology Department, \u2018Victor Babes\u2019 University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), \u2018Victor Babes\u2019 University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emanuela Oana","family":"Costin","sequence":"additional","affiliation":[{"name":"Pulmonology Department, \u2018Victor Babes\u2019 University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrei","family":"Pescaru","sequence":"additional","affiliation":[{"name":"\u2018Victor Babes\u2019 University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5270-1464","authenticated-orcid":false,"given":"Ana-Adriana","family":"Trusculescu","sequence":"additional","affiliation":[{"name":"Pulmonology Department, \u2018Victor Babes\u2019 University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), \u2018Victor Babes\u2019 University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2112-2923","authenticated-orcid":false,"given":"Adelina","family":"Maritescu","sequence":"additional","affiliation":[{"name":"Pulmonology Department, \u2018Victor Babes\u2019 University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), \u2018Victor Babes\u2019 University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Noemi","family":"Suppini","sequence":"additional","affiliation":[{"name":"Pulmonology Department, \u2018Victor Babes\u2019 University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), \u2018Victor Babes\u2019 University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2083-0581","authenticated-orcid":false,"given":"Cristian Iulian","family":"Oancea","sequence":"additional","affiliation":[{"name":"Pulmonology Department, \u2018Victor Babes\u2019 University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), \u2018Victor Babes\u2019 University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.rmedc.2011.03.005","article-title":"Spontaneous pneumomediastinum revisited","volume":"4","author":"Meireles","year":"2011","journal-title":"Respir. Med. CME"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Marza, A.M., Petrica, A., Buleu, F.N., and Mederle, O.A. (2021). Case report: Massive spontaneous pneumothorax\u2014A rare form of presentation for severe COVID-19 pneumonia. Medicina, 57.","DOI":"10.3390\/medicina57020082"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1186\/s13256-021-02701-z","article-title":"Spontaneous primary pneumomediastinum: Is it always benign?","volume":"15","author":"Alemu","year":"2021","journal-title":"J. Med. Case Rep."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Loffi, M., Regazzoni, V., Sergio, P., Martinelli, E., Stifani, I., Quinzani, F., Robba, D., Cotugno, A., Dede, M., and Danzi, G.B. (2020). Spontaneous pneumomediastinum in COVID-19 pneumonia. Monaldi Arch. Chest Dis.","DOI":"10.4081\/monaldi.2020.1399"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1097\/00005792-194412000-00001","article-title":"Malignant interstitial emphysema of the lungs and mediastinum as an important occult complication in many respiratory diseases and other conditions: An interpretation of the clinical literature in the light of laboratory experiment","volume":"23","author":"Macklin","year":"1944","journal-title":"Medicine"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1016\/j.rmr.2020.06.013","article-title":"Spontaneous pneumomediastinum: A rare complication of COVID-19?","volume":"37","author":"Underner","year":"2020","journal-title":"Rev. Des. Mal. Respir."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1089\/lap.2020.0692","article-title":"Clinical Characteristics and Outcome of Pneumomediastinum in Patients with COVID-19 Pneumonia","volume":"31","author":"Gazivoda","year":"2021","journal-title":"J. Laparoendosc. Adv. Surg. Tech. A"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3573","DOI":"10.12998\/wjcc.v8.i16.3573","article-title":"Spontaneous pneumomediastinum in an elderly COVID-19 patient: A case report","volume":"8","author":"Kong","year":"2020","journal-title":"World J. Clin. Cases"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5830\/CVJA-2015-035","article-title":"Dyspnoea and chest pain as the presenting symptoms of pneumomediastinum: Two cases and a review of the literature","volume":"26","author":"Kara","year":"2015","journal-title":"Cardiovasc. J. Afr."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Janssen, J., Kamps, M.J.A., Joosten, T.M.B., and Barten, D.G. (2021). Spontaneous pneumomediastinum in a male adult with COVID-19 pneumonia. Am. J. Emerg. Med.","DOI":"10.1016\/j.ajem.2020.07.066"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Mobarek, S.K. (2020). Persistent unexplained chest pain and dyspnea in a patient with coronary artery disease: A case report. BMC Cardiovasc. Disord.","DOI":"10.1186\/s12872-020-01348-w"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Pescaru, C.C., Mari\u021bescu, A., Costin, E.O., Tr\u0103il\u0103, D., Marc, M.S., Tru\u0219culescu, A.A., Pescaru, A., and Oancea, C.I. (2022). The Effects of COVID-19 on Skeletal Muscles, Muscle Fatigue and Rehabilitation Programs Outcomes. Medicina (Kaunas), 58.","DOI":"10.3390\/medicina58091199"},{"key":"ref_13","first-page":"129","article-title":"Spontaneous pneumomediastinum in a healthy young female: A case report and literature review","volume":"20","author":"Dirweesh","year":"2017","journal-title":"Respir. Med. Case Rep."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.surge.2009.10.007","article-title":"Spontaneous pneumomediastinum (Hamman\u2019s syndrome)","volume":"8","author":"Kelly","year":"2010","journal-title":"Surgeon"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e239489","DOI":"10.1136\/bcr-2020-239489","article-title":"Spontaneous pneumomediastinum, pneumothorax and subcutaneous emphysema in COVID-19 pneumonia: A rare case and literature review","volume":"13","author":"Elhakim","year":"2020","journal-title":"BMJ Case Rep."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/11\/1525\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:03:08Z","timestamp":1760144588000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/11\/1525"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,26]]},"references-count":15,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2022,11]]}},"alternative-id":["medicina58111525"],"URL":"https:\/\/doi.org\/10.3390\/medicina58111525","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,26]]}}}