Introduction
Pneumomediastinum is a rare complication in patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Pneumomediastinum typically resolves with conservative management. Rarely, airway collapse, persistent hemodynamic instability, or progression to cardiac tamponade may require surgical intervention.(1, 2) Described here is a unique case of SARS-CoV-2 infection requiring invasive ventilation that was later complicated by tension pneumomediastinum, which ultimately required operative anterior mediastinal and pericardial drainage. The scant literature on this phenomenon was reviewed, and we discuss the indications and methods for the first operative management of tension pneumomediastinum in a patient with the novel coronavirus disease 2019 (COVID-19).(1)