Spontaneous subcutaneous emphysema and pneumomediastinum in non-intubated patients with COVID-19

Sayan Manna, Samuel Z. Maron, Mario A. Cedillo, Nicholas Voutsinas, Danielle Toussie, Mark Finkelstein, Sharon Steinberger, Michael Chung, Adam Bernheim, Corey Eber, Yogesh Sean Gupta, Jose Concepcion, Richard Libes, Adam Jacobi

Research output: Contribution to journalArticlepeer-review

44 Scopus citations


Purpose: We describe the presenting characteristics and hospital course of 11 novel coronavirus (COVID-19) patients who developed spontaneous subcutaneous emphysema (SE) with or without pneumomediastinum (SPM) in the absence of prior mechanical ventilation. Materials and methods: A total of 11 non-intubated COVID-19 patients (8 male and 3 female, median age 61 years) developed SE and SPM between March 15 and April 30, 2020 at a multi-center urban health system in New York City. Demographics (age, gender, smoking status, comorbid conditions, and body-mass index), clinical variables (temperature, oxygen saturation, and symptoms), and laboratory values (white blood cell count, C-reactive protein, D-dimer, and peak interleukin-6) were collected. Chest radiography (CXR) and computed tomography (CT) were analyzed for SE, SPM, and pneumothorax by a board-certified cardiothoracic-fellowship trained radiologist. Results: Eleven non-intubated patients developed SE, 36% (4/11) of whom had SE on their initial CXR. Concomitant SPM was apparent in 91% (10/11) of patients, and 45% (5/11) also developed pneumothorax. Patients developed SE on average 13.3 days (SD: 6.3) following symptom onset. No patients reported a history of smoking. The most common comorbidities included hypertension (6/11), diabetes mellitus (5/11), asthma (3/11), dyslipidemia (3/11), and renal disease (2/11). Four (36%) patients expired during hospitalization. Conclusion: SE and SPM were observed in a cohort of 11 non-intubated COVID-19 patients without any known cause or history of invasive ventilation. Further investigation is required to elucidate the underlying mechanism in this patient population.

Original languageEnglish
Pages (from-to)207-213
Number of pages7
JournalClinical Imaging
StatePublished - Nov 2020


  • COVID-19
  • Pneumomediastinum
  • Subcutaneous emphysema


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