Introduction: Pneumothorax, pneumomediastinum and pneumopericardium are three clinical conditions in which air is present abnormally within the pleural space, mediastinal peri-bronchial and perivascular areas and pericardial sac respectively. Reports from around the world mentioned COVID-19 inducing the above entities in adult patients either separately (pneumothorax alone) or in combination (pneumomediastinum and pneumopericardium).

Case description: We present the first pediatric case worldwide of a 1-year-old previously healthy girl presenting to the emergency department of Rafik Hariri University Hospital, Lebanon with tachypnea and cyanosis. CT scan of the chest was done and revealed severe massive bilateral pneumothorax, pneumomediastinum and pneumopericardium.

Discussion: COVID-19 is no more the easy-going infection for pediatric population as was thought previously upon the emergence of the pandemic. Many children have been reported to develop multi-organ failure requiring intensive care. A new entity to be feared in pediatric patients is the alveolar rupture into the intrathoracic spaces which may occur even prior to establishment of mechanical ventilation.

Conclusion: High suspicion for severe COVID-19 complications must be present when facing a clinically unstable patient during the COVID-19 pandemic. Rapid intervention must be established to avoid clinical deterioration of the patient.

Keywords: Pneumothorax; Pneumomediastinum; Pneumopericardium; SARS CoV-2; Pediatrics