Spontaneous tension pneumothorax and acute pulmonary emboli in a patient with COVID-19 infection

Khurram, Ruhaid; Johnson, Franklin T F; Naran, Revati; Hare, S.S.

doi:10.1136/bcr-2020-237475

Cited by 17 publications

(16 citation statements)

References 19 publications

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“…Cases of spontaneous pneumothorax have been described in patients suffering from COVID-19 pneumonia . Pneumothoraces have been observed either as a first manifestation of the disease or in a later phase, especially in patients that necessitated orotracheal intubation and mechanical ventilation (31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49). The aim of this study is to systematically review all the cases of spontaneous pneumothorax that occurred in otherwise healthy patients with no underlying lung disease and who were not put under invasive mechanical ventilation and detect similarities and differences comparing to spontaneous pneumothorax encountered before the emergence of this new entity.…”

Section: Introductionmentioning

confidence: 99%

Pneumothorax in otherwise healthy non-intubated patients suffering from COVID-19 pneumonia: a systematic review

Agrafiotis¹,

Rummens²,

Lardinois³

2021

J Thorac Dis

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Background: Cases of spontaneous pneumothorax have been described in patients suffering from coronavirus disease 2019 (COVID-19) pneumonia. The aim of this study is to systematically review all the cases of spontaneous pneumothorax that occurred in healthy patients with no underlying lung disease and who did not receive invasive mechanical ventilation.Methods: A PubMed research was conducted. The following data were collected: age, sex, side of the pneumothorax, smoking habit, time form onset of symptoms to the diagnosis of pneumothorax, the development of new bullous lesions on computed tomography and the type of treatment. In order to analyze the most homogeneous population possible, intubated patients were deliberately excluded. In total, 44 cases of spontaneous pneumothorax in otherwise healthy patients were taken into account. Since the available data were extracted from small observational studies, no particular bias risk assessment was performed.Descriptive statistics were used to synthesize results.Results: There were 37 male (84.1%) and 6 female (13.6%) patients. The majority of patients (66%) were treated only by chest tube thoracostomy, which most of the times resulted in a complete resolution of the pneumothorax. Simple surveillance was applied in 10 cases. Three patients underwent minimally invasive surgery. In 14 cases (31.8%) air-filled lesions were detected on imaging. Eleven patients received corticosteroids during their hospital stay. In the majority of cases (86.3%) the pneumothorax was resolved.Discussion: Even if the level of evidence, derived from case reports and small case series is low, the existence of a true secondary spontaneous pneumothorax due to SARS-CoV-2 should be recognized.Imaging techniques should be repeated throughout the clinical course of the patients in order to detect newly developed pulmonary complications. Surgical treatment is feasible and patients whose general condition permits, should be offered surgery according to the existing guidelines regarding spontaneous pneumothorax. National registries and databases are necessary in order to better understand the pathogenesis and complications of this novel entity.

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Section: Introductionmentioning

confidence: 99%

Pneumothorax in otherwise healthy non-intubated patients suffering from COVID-19 pneumonia: a systematic review

Agrafiotis¹,

Rummens²,

Lardinois³

2021

J Thorac Dis

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“…As in our case, air cyst formation has been reported in COVID‐19 pneumonia, especially secondary pneumothorax [7,11,12]. The mechanism of air cyst formation is presumed to be barotrauma caused by positive pressure ventilation [13].…”

Section: Discussionmentioning

confidence: 52%

“…On the other hand, cases of pneumothorax with air cyst secondary to COVID‐19 pneumonia which were not treated with positive pressure were also reported, for which other mechanisms, such as check‐valve due to bronchial inflammation accompanied by SARS‐CoV‐1 infection, were presumed [7,14]. Air cysts in COVID‐19 pneumonia have been reported to be limited in number as observed from radiological findings [7,11,12]. Considering the successful clinical course of our patient, bronchial occlusion seems to be a prioritized treatment for empyema with broncho‐pleural fistula and pneumothorax secondary to COVID‐19 pneumonia.…”

Section: Discussionmentioning

confidence: 75%

Successful endobronchial occlusion in empyema with broncho‐pleural fistula secondary to COVID‐19 pneumonia: a case report and literature review

Nakano

Kawada

Minami

et al. 2021

Respirology Case Reports

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A few cases of empyema secondary to coronavirus disease 2019 (COVID‐19) pneumonia have been reported. Here, we report our experience of a successful endobronchial occlusion using endobronchial Watanabe spigots (EWSs) for empyema with broncho‐pleural fistula secondary to COVID‐19 pneumonia. A 62‐year‐old man was diagnosed with COVID‐19 and progressed to empyema with broncho‐pleural fistula. Computed tomography (CT) imaging showed cyst formation and the right B 5 b was presumed to be a branch dependent on the cyst. The effusion and air in the pleural cavity were well drained, although the air leak persisted. Endobronchial occlusion was performed for right B 5 a and B 5 b using 7‐ and 5‐mm EWSs (Novatech, France), respectively, and the air leak ceased. This is the first report of successful treatment of empyema with bronchial fistula with endobronchial occlusion. Air leak secondary to COVID‐19 pneumonia with a limited number of air cysts may be a good indication for endobronchial occlusion.

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“…15 16 This case highlights the importance of considering tension hydrothorax as a potential cause of haemodynamic compromise in patients with SARS-CoV-2. Other causes of rapid haemodynamic decline may include massive pulmonary embolism and tension pneumothorax, which we have described elsewhere, 17 and are important considerations when a patient presents with severe hypoxia and breathlessness.…”

Section: Discussionmentioning

confidence: 97%

Tension hydrothorax in a patient with SARS-CoV-2 pneumonitis and pleuralMycobacterium tuberculosis

2021

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Unilateral pleural effusions are uncommonly reported in patients with SARS-CoV-2 pneumonitis. Herein, we report a case of a 42-year-old woman who presented to hospital with worsening dyspnoea on a background of a 2-week history of typical SARS-CoV-2 symptoms. On admission to the emergency department, the patient was severely hypoxic and hypotensive. A chest radiograph demonstrated a large left-sided pleural effusion with associated contralateral mediastinal shift (tension hydrothorax) and typical SARS-CoV-2 changes within the right lung. She was treated with thoracocentesis in which 2 L of serosanguinous, lymphocyte-rich fluid was drained from the left lung pleura. Following incubation, the pleural aspirate sample tested positive for Mycobacterium tuberculosis. This case demonstrates the need to exclude non-SARS-CoV-2-related causes of pleural effusions, particularly when patients present in an atypical manner, that is, with tension hydrothorax. Given the non-specific symptomatology of SARS-CoV-2 pneumonitis, this case illustrates the importance of excluding other causes of respiratory distress.

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Spontaneous tension pneumothorax and acute pulmonary emboli in a patient with COVID-19 infection

Cited by 17 publications

References 19 publications

Pneumothorax in otherwise healthy non-intubated patients suffering from COVID-19 pneumonia: a systematic review

Pneumothorax in otherwise healthy non-intubated patients suffering from COVID-19 pneumonia: a systematic review

Successful endobronchial occlusion in empyema with broncho‐pleural fistula secondary to COVID‐19 pneumonia: a case report and literature review

Tension hydrothorax in a patient with SARS-CoV-2 pneumonitis and pleuralMycobacterium tuberculosis

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