Rapidly developing large pneumatocele and spontaneous pneumothorax in SARS-CoV-2 infection

The coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), evolved into a global pandemic. As ACE2 on the surface of alveolar cells of the lung epithelium is one of the potential target receptors for SARS-CoV-2, the respiratory symptoms are the most common presentation of COVID-19. The aim of our study was to investigate the morphological findings in lung tissue after being infected by SARS-CoV-2 and compare histopathologic changes in patients with COVID-19 infection history who died to those who survived. We analyzed lung tissue samples from 9 patients who died from COVID-19 and from 35 patients with COVID-19 infection history who survived and had undergone lung surgery for different reasons. Most of histopathological changes in autopsy and survivors’ cases overlapped; however, they occurred with different frequency. The predominant histologic finding both in the case of the deceased and the survivors was patchy distribution of foamy macrophages in the alveolar spaces. In comparison with autopsy cases viral cytopathic-like changes in hyperplastic pneumocytes were rarely observed in the survivors’ lung tissue. Pulmonary edema, fibrin deposition within alveoli, bronchopneumonia, small vessel thrombosis and type II pneumocyte hyperplasia were also more often observed within autopsy cases. Life-threatening complications such as hyaline membrane formations and diffuse alveolar damage were present only within the deceased, whereas changes requiring enough time to progress to the fibrotic phase, such as organizing pneumonia, bronchiolization of the alveoli, and interstitial fibrosis were observed in the lung parenchyma only in survivors. Additionally, 14 cases of pulmonary pneumo-hematocele in patients with COVID-19 infection history who survived were observed. It is a newly observed entity in the form of a cystic lesion formed by large accumulation of blood and fibrin between the collapsed and rejected lung parenchyma and/or present with air–fluid levels. The thin wall of pneumo-hematocele is formed by the inter lobar interstitial fibroconnective tissue and has no epithelial lining or bronchial wall elements. As the COVID-19 pandemic continues, new complications following SARS-CoV-2 infection are identified. Newly observed entity in patients with COVID-19 infection history who survived is pulmonary pneumo-hematocele. The appearance of these lesion has become increasingly frequent.

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“…[ 16 ] Moreover, in some instance the pneumatocele can dissect through the pleural membrane causing pneumothorax. [ 11 , 14 , 15 , 49 ]…”

Section: Discussionmentioning

confidence: 99%

Histopathological pulmonary findings of survivors and autopsy COVID-19 cases: A bi-center study

2022

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“…Furthermore, there are several reports of iatrogenic and noniatrogenic pneumatoceles forming in patients with advanced COVID-19 infection [14,15]. These are prone to rupture causing an increased risk of pneumomediastinum, pneumothorax and surgical emphysema [15].…”

Section: Discussionmentioning

confidence: 99%

Pulmonary artery pseudoaneurysm secondary to COVID-19 treated with endovascular embolisation

Khurram

Karia

Naidu

et al. 2021

European Journal of Radiology Open

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Pulmonary artery pseudoaneurysms are uncommon and can cause severe, life-threatening haemoptysis. We present a case of a 74-year-old gentleman who was being treated for COVID-19 pneumonitis and a concomitant segmental pulmonary artery thrombus with conventional treatment and anticoagulation. The patient developed significant haemoptysis during admission. A repeat computed tomography pulmonary angiogram revealed an 8 mm left upper lobe pulmonary artery pseudoaneurysm. Anticoagulation was withheld and the pseudoaneurysm was successfully treated with endovascular embolisation with an Amplatzer® IV plug, leading to resolution of the haemoptysis. To our knowledge this is the first case of a pulmonary artery pseudoaneurysm secondary to COVID-19.

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“…Lung inflammation in COVID causes formation of pneumatocele, which can predispose to spontaneous pneumothorax. There are documented cases of pneumatocele formation as well as its progression and spontaneous rupture in COVID (3). Although formation of pneumatocele is largely facilitated by mechanical ventilation, there are documented cases of spontaneous pneumothorax in patients without mechanical ventilation (4).…”

Section: Discussionmentioning

confidence: 99%

Bilateral spontaneous pneumothorax in a non-intubated COVID-19 patient

Frączek

Sklinda

Walecki

2021

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Spontaneous bilateral pneumothorax is a rare condition occurring only in 1,3% of cases of spontaneous pneumothorax. Although spontaneous pneumothorax is recognized complication of COVID it is usually associated with severe cases of COVID pneumonia with massive lung involvement and a high level of inflammatory cytokines – so called "inflammatory storm". Large percentage of this patients requires life support with mechanical ventilation and pneumothorax is usually accompanied with pneumomediastinum. Nevertheless occurrence of spontaneous pneumothorax in non-intubated patients is very low. Therefore the presented case is exceptional in two ways – spontaneous pneumothorax occurred in non-intubated patient and is presented bilaterally. Early diagnosis of spontaneous bilateral pneumothorax can pose a diagnostic dilemma as it mimics progression of lung involvement in the course of COVID, pulmonary embolism or myocardial infarction. In our case apart from COVID pneumonia, patient had typical clinical presentation of myocardial infarction and known coronary artery disease, which initially mislead clinicians toward diagnosis of myocardial infarction (MI). However after exclusion of MI, chest radiograph was requested which revealed bilateral pneumothorax. The exact mechanism of pneumothorax development in non-intubated patients is not clear. Lung inflammation in COVID causes formation of pneumatocele, which can predispose to spontaneous pneumothorax. It is important to note that our patient developed pneumothorax without evident pneumatocele, underlying lung condition or history of trauma. This case shows that bilateral pneumothorax in COVID-19 can develop also in patients with only mild clinical course of COVID pneumonia. Early diagnosis and proper management is essential and can prevent life-threatening complications.

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Rapidly developing large pneumatocele and spontaneous pneumothorax in SARS-CoV-2 infection

Cited by 11 publications

References 7 publications

Histopathological pulmonary findings of survivors and autopsy COVID-19 cases: A bi-center study

Histopathological pulmonary findings of survivors and autopsy COVID-19 cases: A bi-center study

Pulmonary artery pseudoaneurysm secondary to COVID-19 treated with endovascular embolisation

Bilateral spontaneous pneumothorax in a non-intubated COVID-19 patient

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