• Chunlin Xiang and Gang Wu.
• Department of Radiology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China.
• Medicine (Baltimore). 2020 May 1; 99 (20): e20208.

IntroductionSince the end of 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has affected more than 1,000,000 population in the world. Subcutaneous emphysema and pneumothorax are uncommon complications of SARS-CoV-2 pneumonia. Herein, we describe a fatal case of SARS-CoV-2 pneumonia with subcutaneous emphysema and pneumothorax.Patient ConcernsSubcutaneous emphysema was found in neck, bilateral chest walls, abdomen wall, groin area, and scrotum of a 67-year-old man. Extensive air-space opacities, subcutaneous emphysema and a small amount of pneumothorax were found in his chest X-ray scan. Echocardiography showed left ventricular enlargement with ejection fraction 20%.DiagnosisThis resident of Wuhan with laboratory-confirmed SARS-CoV-2 infection had chronic pulmonary and cardiac diseases. Liver dysfunction, myocardial injury, and coagulation disorder were suggested by laboratory findings. Pneumonia, subcutaneous emphysema, and pneumothorax were confirmed with chest X-ray. Heart failure was revealed by echocardiography.InterventionsHe was transferred to intensive care unit, where invasive ventilation was used for him during the whole hospitalization. Prone position ventilation, vasoconstrictor, antibacteria, and antiviral therapy were given.OutcomesHe died on the twelfth day after admission.ConclusionsSubcutaneous emphysema and pneumothorax may occur in patients with SARS-CoV-2 pneumonia and chronic pulmonary disease. Chronic cardiac disease might be aggravated by SARS-CoV-2 infection, and develop heart failure.

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