Background
Pneumo-mediastinum is usually a benign condition defined as the presence of air in the mediastinum. However, in rare cases, excessive air in this space can increase pressure on vital cardiovascular and respiratory systems causing cardiovascular collapse. This phenomenon is known as tension pneumomediastinum (TPM). TPM is a potentially fatal clinical condition, initially described in the 1940s frequently in pulmonary tuberculosis patients.1 Severe COVID-19 pneumonia may progress to full-blown Acute respiratory distress syndrome within a short period of time. These patients require invasive ventilation with high ventilator settings to maintain their oxygenation requirements. Hence these patients are at a higher risk of developing pneumomediastinum and eventually tension pneumomediastinum (TPM). The literature search revealed one case report TPM and a case series titled “pneumomediastinum in COVID-19 patients”. 2, 3 We report another case series describing five patients of COVID-19 pneumonia who developed tension pneumomediastinum while being given invasive ventilation.