M COVID PNTHX

Case report details bilateral spontaneous pneumothorax in SARS-CoV-2 infection

A COVID-19 case complicated with bilateral spontaneous pneumothorax was detailed in The American Journal of Emergency Medicine.

“Bilateral spontaneous pneumothorax is a very rare, potentially life-threatening complication in patients with COVID-19,” reported Héctor González-Pacheco, National Institute of Cardiology, Mexico City, Mexico, and colleagues.

A previously healthy 45-year-old nonsmoker male was admitted to the emergency department with sudden-onset chest pain and progressive shortness of breath 17 days after diagnosis with uncomplicated COVID-19 infection. 

At admission, the patient denied cough or recent thorax trauma. Clinical examination revealed a heart rate of 100 beats/min, blood pressure 100/60 mmHg, respiration rate 26 breaths/min, and pulse oximetry 75% on ambient air. Additionally, his breath sounds were reported to be diminished bilaterally on auscultation. 

Further, his chest X-ray revealed the presence of a large bilateral pneumothorax and bilateral lung collapse was noted. The authors reported that a chest tube was placed in the left hemithorax under emergency conditions and immediate clinical improvement was observed. 

A subsequent thoracic CT scan demonstrated an ongoing pneumothorax and collapse of the right lung and partial resolution of the left pneumothorax with ill-defined patchy ground-glass opacities and lobar consolidations in the left lower lobe, which were consistent with severe COVID-19 infection. A right hemithorax chest tube was placed, and the patient was transferred to the intensive care unit (ICU).

During ICU hospitalization, the patient was placed on supplemental oxygen, and lopinavir/ritonavir and enoxaparin were administered. He remained afebrile and did not require intubation or mechanical ventilation. Continuous suction was used, and complete expansion of the lungs was noted to be successful. The chest tubes were removed on the ninth day.

Follow-up chest CT scan revealed resolution of bilateral pneumothorax, reduction of parenchymal consolidation, and formation of large bilateral pneumatoceles. The patient remained under observation over the next three days, while he showed significant clinical improvement, after which he was discharged home.

“Although the precise mechanism of spontaneous pneumothorax in COVID-19 is unknown, it may be linked to a variety of factors,” the authors noted, adding that the presence of pneumatoceles in patients with COVID-19 is an “uncommon pathological finding, which may contribute to the likelihood of developing pneumothorax, including distal airway inflammation.”

“This case highlights the importance of considering spontaneous pneumothorax in patients presenting with SARS-CoV-2 infection,” the authors concluded. They suggest that spontaneous pneumothorax should be considered in the diagnosis of these patients because “immediate recognition and management of large tension pneumothorax is required to prevent potentially fatal consequences.”