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.