TYPE: Late Breaking Case Report
TOPIC: Cardiothoracic Surgery
INTRODUCTION: An increasing number of long-term complications due to COVID 19 are emerging. Recently, the appearance of characteristic pulmonary lesions has been noted, described as post-COVID-19 pneumatocele.
CASE PRESENTATION: A 25-year-old male patient presented with cough, fever, shortness of breath, myalgia, and arthralgia; tested positive for COVID 19 by reverse transcription-polymerase chain reaction, twenty days before presentation. He received at-home treatment not requiring oxygen support, only symptomatic medication. Due to hypoxemia and hemoptysis, was admitted to the hospital where a CT scan was taken, identifying bilateral pneumothorax due to bilateral pneumatoceles located in the upper lobes; requiring bilateral pleural drainage. Surgical treatment was decided, and bilateral VATS resection of the pneumatocele was made, identifying the presence of hematic residue in both lesions. He was discharged on postoperative day 4, because of a left alveolar pleural fistula, which remitted spontaneously. Image 1. CT scan with bilateral pneumatoceles in upper lobes of 11.7 cm (left), 8.3 cm (right).
DISCUSSION: We consider that the term “pneumo-hematocele” is more suitable than pneumatocele since the primary lesion appears to be a hematic accumulation due to capillary inflammatory bleeding, with a secondary inflammatory fibrotic process enclosed by the lung parenchyma, with subsequent total or partial reabsorption of the blood.
CONCLUSIONS: Because of the previously described characteristics of pneumo-hematocele, we consider it a different entity from other bullous diseases of the lung, thus, it should be treated differently. These lesions will become more frequent as COVID-19 patients have a more long-term disease, so further research is needed to standardize treatment and follow-up.
DISCLOSURE: Nothing to declare.
KEYWORD: COVID 19