SESSION TITLE: Pathologies of the Post-COVID-19 World
SESSION TYPE: Rapid Fire Case Reports
PRESENTED ON: 10/18/2022 10:15 am - 11:10 am
INTRODUCTION: The development of secondary spontaneous pneumothorax is one of the emerging post-coronavirus-19 disease (COVID-19) complications, more so in mechanically ventilated patients, during the acute phase of infection. High airway pressure delivered during respiratory support is commonly recognized as a potential culprit.
CASE PRESENTATION: A 57-year-old male was hospitalized for a week for COVID-19 pneumonia with acute hypoxic respiratory failure and treated with oxygen supplementation (required high flow oxygen), remdesivir, and dexamethasone. No mechanical ventilatory support was needed. He had a history of significant smoking cigarettes and marijuana in the past. A week after the discharge, he re-presented to the hospital with complaints of worsening cough, chest pain, and difficulty breathing following three episodes of vigorous sneezing. Computed Tomography (CT) chest revealed large left pneumothorax and right lower lobe pneumatocele. Immediate chest tube insertion relieved his symptoms. The final diagnosis of spontaneous pneumothorax secondary to pneumatocele rupture was made in a patient with a history of COVID-19 pneumonia.
DISCUSSION: Cystic lesions resulting from alveolar damage (swelling, inflammation, and fibrosis) with parenchymal damage from the virus, along with barotrauma, are thought to cause pneumothorax. Few cases have been reported in patients without mechanical ventilation. High airway pressures delivered by high flow oxygen, fragile airways due to acute COVID-19 infection, and smoking might have predisposed this patient to pneumatocele, with sneezing leading to rupture and pneumothorax.
CONCLUSIONS: This case demonstrates pneumatocele as a sequela of COVID-19, with a risk of pneumothorax. Medical professionals should consider pneumothorax in patients who recovered from COVID-19 and present with new respiratory symptoms. Further studies are required to evaluate the need for routine follow-up imaging (CT chest) in post-COVID-19 infection for pneumatocele or pneumothorax.
Reference #1: Marzocchi G, Vassallo A, Monteduro FSpontaneous pneumothorax as a delayed complication after recovery from COVID-19BMJ Case Reports CP 2021;14:e243578.
Reference #2: Schiller M, Wunsch A, Fisahn J, Gschwendtner A, Huebner U, Kick W. Pneumothorax with Bullous Lesions as a Late Complication of Covid-19 Pneumonia: A Report on Two Clinical Cases. J Emerg Med. 2021 Nov;61(5):581-586. doi: 10.1016/j.jemermed.2021.04.030. Epub 2021 May 9. PMID: 34916057; PMCID: PMC8106878.
Reference #3: Nunna K, Braun ABDevelopment of a large spontaneous pneumothorax after recovery from mild COVID-19 infectionBMJ Case Reports CP 2021;14:e238863.
DISCLOSURES: No relevant relationships by Ziad Alkhoury
no disclosure on file for Mostafa Mostafa;
No relevant relationships by Roshan Subedi
No relevant relationships by Mohammed Syed
No relevant relationships by Qi Wang