Introduction
Severe acute respiratory syndrome coronavirus (COVID 19) infection has
developed as the greatest pandemic the world with high morbidity and
mortality and several complications. There are lots of studies about
(COVID-19) and its complications(1-3).There are reports about
spontaneous pneumomediastinum (PM), pneumopericardium (PP), pneumothorax
(PT), and subcutaneous emphysema (SE) cases in patients with COVID -19,
and also some of these complications present in the patients with
mechanical ventilation, which results in barotrauma (4). The
pathophysiologic mechanism of PM is an increased gradient pressure
between the alveoli and parenchyma of lung that leads to severe alveolar
injury and the air dissects the surrounding bronchovascular sheaths, and
this air enters into the mediastinum and produces PM and disturbance to
cervical SE and pleural space PT (2, 4). The pulmonary complications are
a sequela of parenchymal, vascular, or pleural involvement and range
from pneumonia to acute respiratory distress syndrome (ARDS) and
pulmonary embolism to pneumothorax (5). Pneumothorax, defined as air
within the pleural space, is one of the emerging complications of
COVID-19 infection (6). Alveolar wall is more prone to rupture due to
inflammation in COVID-19 patients and alveolar wall is exacerbated by
severe cough or any problems which increase the intra-alveolar pressure
(4). Invasive positive pressure ventilation can cause PT, SE, PP and PM
spontaneously, But spontaneous tension pneumopricardium or spontaneous
pneumothorax tension is rare complication in COVID-19 (7). Barotrauma is
the cause of PM, PT, PP, and SE (2). In this case report, we focus only
on hospitalized COVID-19 patients who developed these complications and
diagnosis and treatment.