Nasrin Milani - Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Atefe Golhasani - Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
sharzad lari - Lung Disease Research Center, Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Pouria Hasanpour - Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Sajjad Ataei Azimi - Hematology and Oncology Division, Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Spontaneous pneumothorax is one of the rare complications associated with COVID-۱۹ viral pneumonia, and its exact mechanisms are still unknown. Most often this complication occurs in the setting of mechanical ventilation. This case series reports seven patients with the first presentations of spontaneous pneumothoraxes developing in the absence of mechanical ventilation.This case series study presents seven cases of COVID-۱۹ with a positive COVID-۱۹ PCR test result. A few days had passed from the onset of symptoms, and they had severe pulmonary involvement and high inflammatory markers. The patients received treatment for COVID-۱۹; however, they developed hydropneumothorax and subcutaneous emphysema before being hospitalized or on the first day of hospitalization. A ventilator was used in the case of some patients. The mortality rate was high among these patients.These cases confirm the hypothesis that unusual manifestations of COVID-۱۹ can lead to life-threatening conditions. Therefore, the diagnosis and treatment of these special COVID-۱۹ cases are highly important.

case report, COVID-۱۹, Pneumomediastinum, Pneumothorax, Subcutaneous Emphysema