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The new disease outbreak that causes atypical pneumonia named COVID-19, which started in China’s Wuhan province, has quickly spread to a pandemic. Although the imaging test of choice for the initial study is plain chest radiograph, CT has proven useful in characterizing better the complications associated with this new infection. We describe the evolution of 3 patients presenting pneumomediastinum and spontaneous pneumothorax as a very rare complication of COVID-19 and their particular interest as a probable prognostic factor.

A 46-year-old man presented to the emergency department having had 2 large, nonbloody vomits and abdominal pain over the preceding 3 hours. He had no history of gastresophageal reflux disease or other relevant medical conditions. He had a 20-year history of drinking 10-15 cans of beer a week. On examination, his abdomen was rigid and tender in the left upper quadrant. Laboratory results showed elevated leukocytes at 13.8 (normal 4.5-11.5) × 109/L with 77.8% neutrophils and high sensitivity C-reactive protein of < 0.02 (normal < 0.80) mg/dL. A chest radiograph showed pneumomediastinum, and a subsequent computed tomography scan of the patient's chest also showed pneumomediastinum and left hydropneumothorax. We diagnosed Boerhaave syndrome, perforation of the esophagus.

Correspondence to Dr Vinuta Mohan; vmohan@stfrancismedical.org Description A 49-year-old man presented to the emergency room with 3 days of increasing cough and shortness of breath, both at rest and with minimal exertion, associated with decreased appetite and anosmia. On hospital day #5, the patient reported sudden onset of nausea and vomiting and was noted to have crepitus around his neck and chest area. While most cases are self-limited and managed conservatively, the condition must be monitored carefully as it can lead to life threatening circulatory and respiratory pathology.1 Our patient had no history of pulmonary disease, pneumothorax, or tobacco use.

Correspondence to Dr Serenydd Everden, Department of Respiratory Medicine, Royal Berkshire NHS Foundation Trust, Reading RG1 5AN, UK; serenydd.everden@googlemail.com Case presentation A 57-year-old man with no medical history and <5 pack-year smoking history presented with dyspnoea. Follow-up CT Thorax, day 63 from first presentation, showed persisting ground glass changes and improvement in size of the fluid-filled cystic areas (figure 1C). Follow-up on day 84 demonstrated persisting dyspnoea with forced vital capacity (FVC) 4.86 L (97% predicted), transfer factor of the lung for carbon monoxide (TLCO) 5.85 (53% predicted) and carbon monoxide transfer coefficient (KCO) 0.99 (71% predicted).

The baby was admitted to the neonatal intensive care unit and after he was initially stabilised using continuous positive airway pressure, he required nasal continuous positive airway pressure of 7 mbar. Laboratory investigations found normal C-reactive protein (0·5 mg/dL; normal <1·5) and interleukin-6 concentrations (90·1 pg/mL; normal <100); there was no leukopenia or leukocytosis. [...]in the parasternal view—usually a helpful window for the assessment of the tracheal tube position and where the great vessels are visible below the thymus in the healthy infant—a stairway-like set of horizontal hyperechogenic reflections was seen instead of the great vessels indicating the presence of trapped air below the thymus (figure; video).

Background With the prevalence of coronavirus disease 2019 (COVID-19), many severe cases have been discovered worldwide. Here, a case of concurrent pneumomediastinum, pneumoretroperitoneum, and intestinal perforation was reported. This case was the first report on COVID-19-induced related complications. Case presentation A 74-year-old female patient was hospitalized for COVID-19. Air leakage was unexpectedly found during imaging reexamination. Considering the unobvious subjective feeling of the patient, a conservative treatment was given at the early stage, and finally, sigmoid colon perforation was surgically confirmed. The family gave up the treatment at last, because the patient could not be taken off the ventilator. Coincidentally, the patient also had abnormal renal anatomical position. This situation led to an abnormal air leakage direction and the atypical manifestations of peritonitis. It was also one of the important reasons for the delayed diagnosis and treatment of the disease. Conclusions Clinicians should be vigilant for spontaneous gastrointestinal perforation in patients with COVID-19, particularly those undergoing treatment with glucocorticoids and tocilizumab. The case is shared to highlight this rare and fatal extrapulmonary manifestation of COVID-19 and further assist clinicians to raise their awareness and timely implement imaging investigation and multidisciplinary intervention so as to facilitate early discovery, diagnosis and treatment and reduce the mortality.