Pneumomediastinum due to spontaneous tracheal breach in COVID-19

Patients who have contracted coronavirus disease 2019 (COVID-19) have a wide variety of complications, many of them involving the respiratory system. One noted complication has been pneumomediastinum. The 63-year-old gentleman, in this case, had contracted COVID-19 and was admitted to the hospital for hypoxemia. He required high-flow nasal canula oxygen but did not get intubated. On day 12 of admission, the patient had a rapid hypoxemic episode after rising from a chair and fell. Diffuse airspace infiltrates were seen on chest x-ray, signifying a possible pneumomediastinum. A CT scan confirmed pneumomediastinum, and the likely mechanism was a tracheal breach just superior to the carina. This case highlights a unique mechanism as few papers have described this etiology with such clear imaging. Surgical treatment options were considered since the likely etiology could be traced to the tracheal defect, but the patient was ultimately managed conservatively with high flow nasal cannula oxygen.