Pleural abnormalities in COVID-19: a narrative review

Abstract

Objective: This narrative review aims to provide a detailed overview of pleural abnormalities in patients with coronavirus disease 19 or COVID-19.Background: Severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) is a novel beta coronavirus responsible for COVID-19. Although pulmonary parenchymal and vascular changes associated with COVID-19 are well established, pleural space abnormalities have not been the primary focus of investigations.Methods: Narrative overview of the medical literature regarding pleural space abnormalities in COVID-19. The appropriate manuscripts were identified by searching electronic medical databases and by hand searching the bibliography of the identified papers. Pleural abnormalities on transverse and ultrasound imaging are discussed. The incidence, clinical features, pathophysiology, and fluid characteristics of pleural effusion are reviewed. Studies reporting pneumothorax and pneumomediastinum are examined to evaluate for pathogenesis and prognosis. A brief comparative analysis of pleural abnormalities among patients with COVID-19, severe acute respiratory syndrome (SARS), and Middle Eastern respiratory syndrome (MERS) has been provided.Conclusions: Radiologic pleural abnormalities are common in COVID-19, but the incidence of pleural effusion appears to be low. Pneumothorax is rare and does not independently predispose the patient to worse outcomes. SARS-CoV-2 infects the pleural space; however, whether the pleural fluid can propagate the infection is unclear.

Successful use of endobronchial valve for persistent air leak in a patient with COVID-19 and bullous emphysema

“…The anatomical proximity can lead to damage to the adjacent visceral pleura, leading to the formation of APF, pneumothorax and subsequently PAL. 14 Like our patient, one other reported individual also suffered from bullous emphysema. 11 It is difficult to ascertain the individual contribution of the emphysema or SARS-CoV-2 pneumonia to the pathogenesis of APF in these patients.…”

“…16 Although initially thought to be a rare complication (approximately 1% of patients), the incidence of pneumothorax is much higher in critically ill patients with COVID-19. 14 Based on recent studies, the incidence is approximately 10%. 7 14 Pneumothorax is commonly seen in middle-aged men, predominantly affecting the right side, occurring in both mechanically ventilated and non-ventilated patients.…”

Bilateral parapneumonic pleural effusion with pneumothorax in a patient with covid 19 pneumonia: case report

“…Invasion of the pulmonary parenchyma by SARS-CoV-2 results in intense inflammation that causes diffuse alveolar injury and endothelial damage by the inflammatory cells [6] . This results in an increased interstitial fluid content due to leaky microvasculature.…”

“…Pleural effusion typically develops later in the disease process. Based on the reported case series and meta-analyses, the incidence has typically varied between 2%-11% [ 5 , 6 ]. The frequency of pleural effusions varies with age and disease severity.…”

Unusual Presentation of a Rare Pneumothorax in a Patient With COVID-19 Pneumonia: A Case Report

“…Additionally, a higher expression of a transmembrane serine protease 2 encoded by TMPRSS2 gene disproportionately found in nasal epithelial cells of individuals that self-identified as Black Americans allows for a greater burden of COVID-19 viral entry and spread via airway [ 18 ]. We, therefore, assume that, although the patient did not endorse a history of pulmonary disease, the inflammatory response to the virus resulted in enough alveolar damage to cause air to leak through the alveoli and escape into the pleural space [ 19 - 20 ]. These changes likely predisposed him to develop the PTX.…”