{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:27:43Z","timestamp":1760059663714,"version":"build-2065373602"},"reference-count":30,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,6,29]],"date-time":"2025-06-29T00:00:00Z","timestamp":1751155200000},"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>Background and Objectives: Infection with SARS-CoV-2, the etiologic agent of Coronavirus 2019, spread rapidly globally after the first case was reported in Wuhan, China. Multiple respiratory complications, including pneumothorax and pneumomediastinum, have been observed. This study presents an analysis of 100 patients diagnosed with these conditions in the context of SARS-CoV-2 infection. Materials and Methods: This study was conducted between March 2020 and February 2021 and included patients from two hospital units designated for the management of patients with SARS-CoV-2 infection. Demographic data, laboratory investigation results, imaging assessments, medical-surgical management strategies, and survival data were recorded. Results: The study included 100 patients with confirmed SARS-CoV-2 infection (mechanically ventilated and non-ventilated). Of these, 57 patients presented with pneumothorax, 26 of whom also had associated pneumomediastinum and 43 of whom were diagnosed with pneumomediastinum alone. There was a higher incidence of pneumothorax among male patients. Also, 22 patients had concomitant subcutaneous emphysema. Regarding therapeutic management, 36 pleural drains were performed. Bilateral pneumothorax was identified in five patients. Conclusions: The presence of pneumothorax was correlated with a decreased survival rate among patients diagnosed with COVID-19. Also, performing pleural drainage in patients with pneumothorax and COVID-19 pneumonia did not significantly influence the prognosis of the underlying disease.<\/jats:p>","DOI":"10.3390\/medicina61071182","type":"journal-article","created":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T03:54:28Z","timestamp":1751255668000},"page":"1182","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pneumothorax and Pneumomediastinum in SARS-CoV-2 Infection"],"prefix":"10.3390","volume":"61","author":[{"given":"C\u0103t\u0103lina","family":"Aldea","sequence":"first","affiliation":[{"name":"Doctoral School, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irina Mihaela","family":"Abdulan","sequence":"additional","affiliation":[{"name":"Department of Medical Specialties I, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bogdan Mihnea","family":"Ciuntu","sequence":"additional","affiliation":[{"name":"Department of General Surgery, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Negru","sequence":"additional","affiliation":[{"name":"Department of Medical Specialties I, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C\u0103t\u0103lina Mihaela","family":"Luca","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2511","DOI":"10.1002\/jmv.25891","article-title":"Analysis of 92 deceased patients with COVID-19","volume":"92","author":"Yang","year":"2020","journal-title":"J. Med. Virol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1177\/08850666221091441","article-title":"Incidence and clinical features of pneumomediastinum and pneumothorax in COVID-19 pneumonia","volume":"37","author":"Muhamed","year":"2022","journal-title":"J. Intensive Care Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"20352","DOI":"10.1148\/radiol.2020202352","article-title":"High incidence of barotrauma in patients with COVID-19 infection on invasive mechanical ventilation","volume":"297","author":"McGuinness","year":"2020","journal-title":"Radiology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/S0140-6736(20)30211-7","article-title":"Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study","volume":"395","author":"Chen","year":"2020","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e00028","DOI":"10.1148\/ryct.2020200028","article-title":"Chest imaging appearance of COVID-19 infection","volume":"2","author":"Kong","year":"2020","journal-title":"Radiol. Cardiothorac. Imaging"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1183\/09059180.00005310","article-title":"Spontaneous pneumothorax: Epidemiologie, patophysiology and cause","volume":"19","author":"Noppen","year":"2010","journal-title":"Eur. Respir. Rev."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"460","DOI":"10.4103\/1947-2714.117296","article-title":"Spontaneous pneumomediastinum time for consensus","volume":"5","author":"Sahni","year":"2013","journal-title":"N. Am. J. Med. Sci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"7488","DOI":"10.21037\/jtd-20-1687","article-title":"Pneumothorax as the presenting manifestation of COVID-19","volume":"12","author":"Ayazi","year":"2020","journal-title":"J. Thorac. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1186\/s13019-023-02331-0","article-title":"COVID-19 and spontaneous pneumothorax: A survival analysis","volume":"18","author":"Ershadi","year":"2023","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3642","DOI":"10.1053\/j.jvca.2021.02.008","article-title":"Predictors of pneumothorax\/pneumomediastinum in mechanically ventiled COVID-19 patients","volume":"35","author":"Belletti","year":"2021","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2002697","DOI":"10.1183\/13993003.02697-2020","article-title":"COVID-19 and pneumothorax: A multicentre retrospective case series","volume":"56","author":"Martinelli","year":"2020","journal-title":"Eur. Respir. J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1016\/j.chest.2020.11.013","article-title":"Spanish Investigators on Emergency Situations Team (SIESTA) Network. Frequency, Risk Factors, Clinical Characteristics, and Outcomes of Spontaneous Pneumothorax in Patients with Coronavirus Disease 2019: A Case-Control, Emergency Medicine-Based Multicenter Study","volume":"159","author":"Llorens","year":"2021","journal-title":"Chest"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.resinv.2023.12.001","article-title":"Clinical features of pneumothorax associated with COVID-19: A retrospective analysis of two centres","volume":"62","author":"Fujita","year":"2024","journal-title":"Respir Investig."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1186\/s13019-020-01343-4","article-title":"Spontaneous pneumothorax as unusual presenting symptom of COVID-19 pneumonia: Surgical management and pathological findings","volume":"15","author":"Bellini","year":"2020","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1056\/NEJM200003233421207","article-title":"Spontaneous pneumothorax","volume":"342","author":"Sahn","year":"2000","journal-title":"N. Engl. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e000498","DOI":"10.1136\/tsaco-2020-000498","article-title":"Tube thoracostomy during the COVID-19 pandemic\u2014Quidance and recommendations from the AAST Acute Care Surgery and Critical Care Committees","volume":"5","author":"Pieracci","year":"2020","journal-title":"Trauma Surg. Acute Care Open"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1016\/S1473-3099(20)30156-0","article-title":"COVID-19 with spontaneous pneumomediastinum","volume":"20","author":"Zhou","year":"2020","journal-title":"Lancet Infect. Dis."},{"key":"ref_18","first-page":"e8996","article-title":"Spontaneous pneumomediastinum\/pneumothorax in patients with COVID-19","volume":"12","author":"Eperjesiova","year":"2020","journal-title":"Cureus"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.1111\/anae.15113","article-title":"Pneumomediastinum following intubation in COVID-19 patients: A case series","volume":"75","author":"Wali","year":"2020","journal-title":"Anaesthesia"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Taha, M., Elahi, M., Wahby, K., and Samavati, L. (2022). Incidence and risk factors of COVID-19 associated pneumothorax. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0271964"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"R440","DOI":"10.1186\/cc3736","article-title":"Pneumothorax and mortality ventilated SARS patients: A prospective clinical study","volume":"9","author":"Dubin","year":"2005","journal-title":"Crit. Care"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"103134","DOI":"10.1016\/j.amsu.2021.103134","article-title":"Spontaneous pneumothorax with coronavirus disease 2019 in non-ventilated patients: A single-center retrospective case series","volume":"72","author":"Kawachi","year":"2021","journal-title":"Ann. Med. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1186\/s12931-020-01504-y","article-title":"Pneumothorax in COVID-19 disease- incidence and clinical characteristics","volume":"21","author":"Zantah","year":"2020","journal-title":"Respir. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1007\/s10140-020-01806-0","article-title":"Pneumomediastinumand spontaneous pneumothorax as an extrapulmonary complication of COVID-19 disease","volume":"27","year":"2020","journal-title":"Emerg. Radiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"taaa062","DOI":"10.1093\/jtm\/taaa062","article-title":"COVID-19 with spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema","volume":"27","author":"Wang","year":"2020","journal-title":"J. Travel Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1016\/j.hrtlng.2020.06.005","article-title":"Unusual presentations of COVID-19 pneumonia on CT scans with spontaneous pneumomediastinum and loculated pneumothorax; a report of two cases and a review of the literature","volume":"49","author":"Brogna","year":"2020","journal-title":"Heart Lung"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e236519","DOI":"10.1136\/bcr-2020-236519","article-title":"Spontaneous pneumomediastinum in COVID-19","volume":"13","author":"Mohan","year":"2020","journal-title":"BMJ Case Rep."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"3977","DOI":"10.2147\/JMDH.S441798","article-title":"Determinants of Pneumothorax Among Mechanically Ventilated COVID-19 Intensive Care Unit Patients, a Single Centre Study","volume":"16","author":"Hundie","year":"2023","journal-title":"J. Multidiscip. Healthc."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"106464","DOI":"10.1016\/j.rmed.2021.106464","article-title":"Pneumothorax in critical ill patients COVID-19 infection: Incidence, clinical characteristics and outcomes in case control multicenter study","volume":"184","author":"Chopra","year":"2021","journal-title":"Respir. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1016\/j.mayocpiqo.2022.04.003","article-title":"Characteristics and Factors Associated with Mortality in Patients with Coronavirus Disease 2019 and Pneumothorax","volume":"6","author":"Malik","year":"2022","journal-title":"Mayo Clin. Proc. Innov. Qual. Outcomes"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/7\/1182\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:01:18Z","timestamp":1760032878000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/7\/1182"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,29]]},"references-count":30,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["medicina61071182"],"URL":"https:\/\/doi.org\/10.3390\/medicina61071182","relation":{},"ISSN":["1648-9144"],"issn-type":[{"type":"electronic","value":"1648-9144"}],"subject":[],"published":{"date-parts":[[2025,6,29]]}}}