TY - JOUR T1 - Radiological-pathological signatures of patients with COVID-19-related pneumomediastinum: is there a role for sonic-hedgehog and Wnt5a pathways? JF - ERJ Open Research JO - erjor DO - 10.1183/23120541.00346-2021 SP - 00346-2021 AU - Baratella Elisa AU - Bussani Rossana AU - Zanconati Fabrizio AU - Marrocchio Cristina AU - Fabiola Giudici AU - Braga Luca AU - Maiocchi Serena AU - Berlot Giorgio AU - Volpe Maria Concetta AU - Moro Edoardo AU - Confalonieri Paola AU - Cova Maria Assunta AU - Confalonieri Marco AU - Salton Francesco AU - Ruaro Barbara Y1 - 2021/01/01 UR - http://openres.ersjournals.com/content/early/2021/06/17/23120541.00346-2021.abstract N2 - Pneumomediastinum (PM) is a rare complication of acute respiratory distress syndrome (ARDS) when air leaks into the mediastinum. An increased PM incidence, of up to 5–13%, was reported during the COVID-19 pandemic [1, 2] and even occurred spontaneously without a history of mechanical ventilation [3], similarly to the previous SARS-1 [4]. Almost half of the 30 consecutive COVID-19 patients who had prolonged invasive mechanical ventilation had full-thickness tracheal lesions and PM [5]. Although pronation and high PEEP levels were presumed to be the putative causes of PM [5], the mechanism of this COVID-19 complication remains unknown. We hypothesize that sonic hedgehog (SHH) and Wnt5a signaling, crucial pathways in tracheal morphogenesis, and repair/regeneration of cartilage lesions in adulthood [6, 7], could play a role in PM-related COVID-19 tracheal lesions.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Baratella Elisa has nothing to disclose.Conflict of interest: Bussani Rossana has nothing to disclose.Conflict of interest: Zanconati Fabrizio has nothing to disclose.Conflict of interest: Marrocchio Cristina has nothing to disclose.Conflict of interest: Fabiola Giudici has nothing to disclose.Conflict of interest: Braga Luca has nothing to disclose.Conflict of interest: Maiocchi Serena has nothing to disclose.Conflict of interest: Berlot Giorgio has nothing to disclose.Conflict of interest: Volpe Maria Concetta has nothing to disclose.Conflict of interest: Moro Edoardo has nothing to disclose.Conflict of interest: Confalonieri Paola has nothing to disclose.Conflict of interest: Cova Maria Assunta has nothing to disclose.Conflict of interest: Confalonieri Marco has nothing to disclose.Conflict of interest: Salton Francesco has nothing to disclose.Conflict of interest: Ruaro Barbara has nothing to disclose. ER -