COVID-19 with cystic features on computed tomography

Abstract

Rationale: The cystic features of the novel coronavirus disease 2019 (COVID-19) found on computed tomography (CT) have not yet been reported in the published literature. We report the cystic chest CT findings of 2 patients confirmed to have COVID-19-related pneumonia. Patient concerns: A 38-year-old man and a 35-year-old man diagnosed with severe COVID-19 pneumonia were admitted to the intensive care unit. Diagnoses: Chest CT findings showed multiple cysts in ground-glass opacities (bilaterally) with/without pneumothorax. The cysts had a smooth inner wall. Interventions: The patients continued to be given oxygen by mask and received antitussive, phlegm-dispelling treatment. Outcomes: At follow up, there was a reduction in the number of multiple cystic lesions on CT. To date, 1 patient was discharged from hospital, while the other had been transferred to the rehabilitation department. Lessons: COVID-19 may independently result in pulmonary cyst formation and pneumothorax; the application of a ventilator may be another causative factor.

Development of bullous lung disease in a patient with severe COVID-19 pneumonitis

“…It is important to stress that it is not known whether the development of severe bullous disease in our patient was purely coincidental or related to COVID-19 pneumonitis, CPAP or both. However, there have been case reports of pneumothoraces 5 and the development of cystic lung disease and pneumatocele 6 7 in patients with COVID-19 pneumonitis. However, there is no known link between CPAP and the development of new bullous lung disease.…”

Pleural diseases and COVID-19: ubi fumus, ibi ignis

“…The pathological basis for pneumothorax in non-ventilated COVID-19 patients is uncertain. While not usually seen in autopsy reports, lung cavitation and/or cystic lesions unrelated to the use of mechanical ventilation can occur in COVID-19 [ 32 ]. The severe cough that may be associated with COVID-19 and the corresponding increase in intrapulmonary pressure may precipitate the rupture of viral-induced damaged alveoli of peripheral location and pneumothorax formation.…”

A case of secondary tension pneumothorax in COVID-19 pneumonia in a patient with no prior history of lung disease

“…These changes have also been described in SARS and MERS coronavirus infection. 14 , 15 Thus, we postulate that our patient developed a secondary tension pneumothorax in the setting of possible cystic change with bullae, along with increased trans-alveolar pressure from coughing resulting in an air leak. It may be possible that the development of a tension pneumothorax may represent a severe sequela along a continuum where cysts and bullae form, and pneumothorax and pneumomediastinum occur because of lung injury related to COVID-19 infection with a tension pneumothorax occurring possibly due to greater force of coughing in the setting of greater degree of lung damage.…”