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Spontaneous pneumomediastinum in patients with severe acute respiratory syndrome

¹ Dept of Medicine, ² Intensive Care Unit, and ³ Dept of Radiology, United Christian Hospital, and ⁴ Dept of Microbiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China

CORRESPONDENCE: C.M. Chu, Division of Respiratory Medicine, Dept of Medicine, United Christian Hospital, Hong Kong SAR, China. Fax: 85 223472325 E-mail: nncmchu@netvigator.com

Keywords: Complication, coronavirus, pneumomediastinum, pneumothorax, severe acute respiratory syndrome

Received: August 22, 2003
Accepted January 22, 2004

Spontaneous pneumomediastinum (SP) unrelated to assisted ventilation is a newly recognised complication of severe acute respiratory syndrome (SARS). The objective of the present study was to examine the incidence, risk factors and the outcomes of SP in a cohort of SARS victims from a community outbreak.

Data were retrieved from a prospectively collected database of virologically confirmed SARS patients. One hundred and twelve cases were analysable, with 13 patients developing SP (11.6%) at a mean±sd of 19.6±4.6 days from symptom onset.

Peak lactate dehydrogenase level was associated with the development of SP. SP was associated with increased intubation and a trend towards death. Drainage was required in five cases. For patients who survived, the SP and/or the associated pneumothoraces took a median of 28 days (interquartile range: 15–45 days) to resolve completely.

In conclusion, spontaneous pneumomediastinum appeared to be a frequent complication of severe acute respiratory syndrome. Further research is needed to investigate its pathogenesis.

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