Ring around the artery sign- A rare indicator of pneumomediastinum in COVID-19

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Introduction

A 68 years old gentleman presented with high grade fever and abdominal pain for one week. He had COVID 19 six weeks back with post-COVID lung fibrosis and was on home oxygen therapy. He was hypoxic with SpO2 of 93% on venturi-mask with FIO2 of 0.4 and Blood pressure of 80/40 mmHg. Total leucocyte count was elevated to 22 × 109/L. X-ray chest revealed air lucency around the pulmonary trunk (Ring around the artery Sign) (Fig 1). Diagnosis of post-COVID lung fibrosis and pneumomediastinum with superimposed bacterial pneumonitis with sepsis was made. Subsequent computed tomographic scan of chest confirmed pneumomediastinum. He was given oxygen, antibiotics, and supportive care. He improved in 72 hours and could be discharged in hemodynamically stable condition. Spontaneous pneumomediastinum in absence of mechanical ventilation is a rare complication of COVID-19 pneumonia, likely related to damage and rupture of the alveolar membrane [1,2]. Ring around the artery sign results from the accumulation of air around the intramediastinal segment of the pulmonary artery on the right side and is reported rarely as the main radiological sign of pneumomediastinum [3]. Our case illustrates the importance of astute observation of the X-ray chest in COVID 19.

Figure 1: X-ray chest revealed air lucency around the pulmonary trunk (Ring around the artery sign).

Funding

This research received no external funding.

Conflicts of Interest

The authors declare no competing interests.

All authors declare that the material has not been published elsewhere, or has not been submitted to another publisher.

Data Availability

Authors declare that all related data are available concerning researchers by the corresponding author's email.

Acknowledgments

None.

REFERENCES

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Received: 25-Jan-2022, Manuscript No. ipaom-22-12668; Editor assigned: 28-Jan-2022 Pre QC No. P-12668; Reviewed: 17-Feb-2022, QC No. Q-12668; Revised: 22-Feb-2022, Manuscript No. R-12668; Published: 10-Mar-2022