Pleural effusion as an isolated finding in COVID-19 infection.

Common radiological findings of COVID -19 infection include bilateral ground-glass opacities in lower lobes with a peripheral distribution. Pleural effusion is considered a rare manifestation of COVID -19 infection. We present a 52 years old patient with a three-week history of right-sided pleuritic chest pain, fever, and dyspnea. Laboratory investigations revealed high C-reactive protein and ferritin levels and a positive COVID-polymerase chain reaction (PCR) from a nasopharyngeal swab. Chest X-ray and Computed tomography (CT) identified a moderate right-sided pleural effusion, which was exudative with mixed cellularity and high Lactate dehydrogenase (LDH). Histopathology of thoracoscopic pleural biopsy didn't reveal granulomas, malignancy, or any microbiological growth. We postulate that having ruled out any other cause the effusion was likely related to the Covid-19 infection. Our case highlights that COVID-19 can present with isolated pleural effusions, therefore it should be kept as an etiology of effusions especially if other possible causes have been ruled out.

Pneumothorax In Covid-19 Pneumonia: A case series.

BACKGROUND: Coronavirus disease 2019 (Covid-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It mainly affects the lungs and common symptoms are fever, cough and shortness of breath. Pneumothorax has been noted to complicate Covid-19 cases requiring hospital admission, however the exact incidence and risk factors are still unknown. DISCUSSION: We present a series of 3 cases of primary spontaneous pneumothorax with Covid-19 pneumonia. All cases in our series did not require positive pressure ventilation and none had any pre-existing lung disease. All were never smokers and had favourable outcomes despite having severe Covid-19 with a pneumothorax during the course of the disease. In our literature review we discuss several plausible mechanisms and risk factors resulting in a pneumothorax with Covid-19. CONCLUSION: Our cases are a reminder that an acute deterioration with hypoxia in a Covid-19 patient could indicate a pneumothorax. Pneumothorax is one of the reported complications in Covid-19 and clinician vigilance is required during assessment of patients, as both share the common symptom of breathlessness and therefore can mimic each other.