Life-threatening pneumothorax after release from isolation with COVID-19 pneumonia.

Pneumothorax was previously considered as a complication of severe coronavirus disease 2019 (COVID-19) pneumonia. However, it is now known that pneumothorax can develop in other cases. Here, we describe the case of a patient who developed tension pneumothorax after release from isolation from COVID-19 pneumonia. The patient was admitted to our hospital with severe COVID-19 pneumonia on the 10th day after onset. Ventilatory management was carried out on the first day of admission; however, the patient was weaned off the next day. The treatment course was uneventful. On the morning of discharge from the hospital, the patient experienced sudden dyspnea. Chest radiography revealed a large left-tension pneumothorax with a mediastinal shift to the right. As this finding required immediate attention, a chest tube was inserted. Chest computed tomography (CT) showed an airspace in the left thoracic cavity and subpleural thin-walled cystic lesions, such as bullae in the left lobe. One month later, chest CT showed resolution of the cystic lesions. The development of pneumothorax in COVID-19 pneumonia should be considered not only in cases of severe illness, but also after release from isolation. Recently, revisions to measures against COVID-19 have been considered worldwide, including shortening of the isolation period and reviewing the identification of all cases. This is an educational report demonstrating that life-threatening pneumothorax may develop after release from isolation due to COVID-19 pneumonia.

BULLOUS/CYSTIC LUNG CHANGES: RARE RADIOGRAPHIC MANIFESTATIONS AFTER COVID-19

SESSION TITLE: Pathologies of the Post-COVID-19 World SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 10:15 am - 11:10 am INTRODUCTION: Chest radiograph has played a vital role during the Covid 19 pandemic. It has allowed early diagnosis and to assess the severity of infection. Bullous lung lesions associated with Covid 19 are of the rare occurrence. So far very minimal literature is available on the Cystic/Bullous lung changes after Covid 19. We hereby present a case of a young patient with Covid 19 who developed cystic and bullous lung changes. CASE PRESENTATION: 44-year-old man nonsmoker with no significant PMHx admitted to hospital with Covid 19 pneumonia. Patient was extremely hypoxic with SPO2 81% upon arrival to the ER. Which improved significantly after supplemental oxygen. Chest x-ray was suggestive of bilateral peripheral airspace opacities. CT Angio chest showed diffuse ground glass opacification and bilateral pulmonary embolism. Patient received Dexamethasone, Remdesivir and Tocilizumab. Patient improved and was discharged home with oxygen and Apixaban. Repeat CT scan was performed after 2 months was suggestive of evolving cystic and bullous lesions (image 1). Pulmonary function test was suggestive of moderate restrictive pattern with mildly decreased DLCO. Family history was not significant. Detailed workup for cystic lung disease including bronchoscopy with bronchoalveolar lavage and bronchial brushing came back negative. Given the peripheral nature of these lesions, patient was advised to avoid strenuous activities to avoid complications like pneumothorax/pneumomediastinum. Patient continued to do well, Bullous lesions continued to improve on serial CT scans, without need for any surgical interventions. DISCUSSION: The common radiographic manifestations of Covid 19 are consolidation, ground glass opacification, mosaic attenuation, honeycombing, reticulation and air bronchograms (1). Atypical radiographic manifestation of Covid 19 pneumonia places a new challenge for the ongoing Covid 19 pandemic. The exact pathophysiology behind cystic/bullous lung lesions after Covid 19 is unclear however, it is likely from parenchymal damage, pulmonary fibrosis leading to decreased compliance versus direct lung injury by the virus. More research is warranted to identify the actual prevalence, risk factors and long-term clinical outcomes in such patients. Our patient remained clinically stable and was taken off oxygen within a few weeks upon hospital discharge and did not require any surgical intervention. CONCLUSIONS: With this case, we would like to add the following to the current literature: 1. Bullous/Cystic lung changes is one of rare post COVID 19 Sequela 2. Early detection and timely management can prevent life-threatening complications like pneumothorax/pneumomediastinum 3. Covid 19 should be considered as one of the differentials when dealing with Bullous/Cystic lung disease Reference #1: 1. Pednekar,P et al. doi.org/10.3389/fmed.2021.770778 DISCLOSURES: No relevant relationships by Belice Cabrera No relevant relationships by Belice Cabrera No relevant relationships by Parita Soni

Multiple Massive Bullae Formation Within Lung of SARS-CoV-2-Infected Patient.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has altered the world for more than two years and continues to impact the globe in numerous ways. This disease has a wide spectrum of presentations that can range from no symptoms at all to rapid decline and death. Complications of SARS-CoV-2 include acute respiratory failure, pneumonia, acute respiratory distress syndrome (ARDS), acute liver injury, acute cardiac injury, septic shock, blood clots, multisystem inflammatory syndrome in children, and chronic fatigue. Although many complications such as these and others exist, we are still seeing novel developments related to the virus. In this case report, we present a patient with SARS-CoV-2 who concurrently had a massive left lung bulla of unknown etiology. Due to the size and scale of this bulla, we suspect it to be a complication of his SARS-CoV-2 infection. A few cases have been described in the literature beforeand here we would like to contribute another one. Our goal is to help expand the body of evidence demonstrating the far-reaching and atypical nature that SARS-CoV-2 can present with today.

Scars of a long battle - A rare case of post covid vanishing lung

Introduction: Vanishing lung syndrome , a primary bullous disease of the lung is defined as a large bulla occupying at least one third of a hemithorax. Usually it associated with riskfactors of smoking, marijuana abuse, alpha 1 antitrypsin deficiency. Here we present a rare case of vanishing lung syndrome developed in a post covid patient without any comorbidities making it a rare presentation. History: A 35year,male with no significant cigaratte smoking presented with acute onset dyspnoea along with dry cough and right sided chest pain for 1 week duration .no history of any recent trauma Past history of COVID 19 one month back, he was hospitilized was put on NIV and HFNC and was discharged on domicillary oxygen and other medications. Clinical Findings: On examination there was hyperresont note in right side along with diminished air entry in all areas in right side along with left side mammary, infraaxillary, infrascapular areas. Diagnosis and Management: Diagnosis was made with the help of contrast enchanced computed tomography aided by other serological and microbilogical workup. Patient was managed conservatively antibiotics ,analgesics and other supportive measures. Learning Points: We are well aware of lung fibrosis post covid , our intention was to throw light into the new entity of bullous lung disease Bullous lung disease (with or without pneumothorax) should be part of differential diagnosis in a patient returning with chest pain and dyspnoea after SARS-Cov-2 infection.CT imaging essential to differentiate radiographically presumed complex pneumothoraces from large bullae to prevent erroneous chest drain insertion into a bulla.

A case series on bullous lung disease in post COVID patients

Introduction: After the aftermath of covid 19 we are left to learn and understand the multiple respiratory manifestations of post covid 19 sequele The presence of bullous lung disease in post covid patients is one such a rare entity ,has been infrequently reported, studied Eventhough the exact mechanism of formation of bullae in post covid 19 are unknown, an emerging association has been observed.A bulla is an air containing space within the lung parenchyma that arises from destruction dilatation and confluence of airspaces distal to terminal bronchioles and is larger than 1 cm in diameter .Its wall are composed of attenuated and compressed parenchyma. Here in this case series we describe this unique presentation of bullous lung diseases in post covid 19 patients. Case Series: Here wepresent a case series of 7 patients without any known comorbidities who were diagnosed with post covid bullous lung disease Diagnosis was made with the help of contrast enchanced computed tomography aided by other serological and microbilogical workup. Patient was managed conservatively antibiotics, analgesics and other supportive measures. Learning Points: We are well aware of lung fibrosis post covid, our intention was to throw light into the new entity of bullous lung disease in post covid period. Bullous lung disease (with or without pneumothorax) should be part of differential diagnosis in a patient returning with chest pain and dyspnoea after SARSCov- 2 infection. CT imaging essential to differentiate radiographically presumed complex pneumothoraces from large bullae to prevent erroneous chest drain insertion into a bulla.

[Development of a giant bulla under spontaneous breathing by self-inflicted lung injury in a patient with COVID-19 pneumonia]. / Entwicklung einer Riesenbulla unter Spontanatmung durch "patient self-inflicted lung injury" bei COVID-19-Pneumonie.

The outbreak of SARS-CoV­2 and the associated COVID-19 pandemic pose major challenges to healthcare systems worldwide. New data on diagnosis, clinical presentation and treatment of the disease are published on a daily basis. This case report describes the fatal course of severe COVID-19 pneumonia in an 81-year-old patient with no previous pulmonary disease who developed a giant bulla during non-invasive high-flow oxygen therapy. Virus-induced diffuse destruction of alveolar tissue or patient self-inflicted lung injury (P-SILI) are discussed as possible pathomechanisms. Future studies must determine whether lung-protective mechanical ventilation with high levels of sedation and paralysis to suppress spontaneous respiratory drive and to reduce transpulmonary pressure can prevent structural lung damage induced both by the virus and P­SILI in COVID-19 patients with ARDS.

Pneumothorax with Bullous Lesions as a Late Complication of Covid-19 Pneumonia: A Report on Two Clinical Cases.

BACKGROUND: Coronavirus-19 disease (COVID-19) primarily affects the respiratory tract, causing viral pneumonia with fever, hypoxemia, and cough. Commonly observed complications include acute respiratory failure, liver or kidney injury, and cardiovascular or neurologic symptoms. In some patients, inflammatory damage results in long-term complications, such as pulmonary fibrosis, chronic pulmonary thrombotic microangiopathy, or neurologic symptoms. The development of spontaneous pneumothorax is reported as a rare complication mainly in consequence to mechanic ventilation in the criticall ill. CASE REPORT: We report 2 cases of patients with COVID-19 pneumonia complicated by spontaneous pneumothorax and bullous lesions of the lung. Bilateral giant bullae were observed in 1 of the cases. This complication occurred after an initial resolvement of respiratory symptoms (day 16 and day 29 after COVID-19 treatment was started). Initially, both patients had shown a rather mild course of COVID-19 pneumonia and no mechanical ventilatory support had been necessary. Why Should an Emergency Physician Be Aware of This?: In both cases, COVID-19 caused alveolar damage and the formation of thoracic bullae with consequent spontaneous pneumothorax as a serious complication. Emergency physicans must be aware of this complication even if the initial COVID-19 symptoms have resolved. © 2021 Elsevier Inc.

A case of bulla formation after treatment for COVID-19 pneumonia.

In December 2019, coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was reported in Wuhan, China. An 82-year-old woman presented to our hospital with high fever (39°C) and chest computed tomography revealed ground-glass opacities in the left lung apex. She was positive for SARS-CoV-2 based on a polymerase chain reaction test, and diagnosed with COVID-19 pneumonia. 6 months after treatment, chest CT showed a large bulla (47 mm × 29 mm) in the left lung apex, although pneumonia had partially resolved. Radiologic follow-up is needed after COVID-19 pneumonia, because patients may develop bullae after treatment.

Hemoptysis and a Newly Formed Lung Bulla in a Case of Convalescent COVID-19 Pneumonia.

Coronavirus disease 2019 (COVID-19) is a novel infectious disease affecting the general population worldwide. A fever and cough are the common clinical presentations of COVID-19. In most of these patients, computed tomography (CT) shows bilateral peripheral ground-glass opacities. We herein report a case of hemoptysis and lung bulla in the convalescent phase of COVID-19. Based on the clinical observations, alveolar destruction was likely associated with hemoptysis and bulla formation. Therefore, we suggest the follow-up of COVID-19 patients whose clinical parameters indicate alveolar damage, even after their symptoms improve.

Pneumothorax in a COVID-19 Pneumonia Patient without Underlying Risk Factors.

Coronavirus disease 2019 (COVID-19) has been recognized as a worldwide pandemic. However, the clinical course of COVID-19 remains poorly characterized. Although some cases of pneumothorax have been reported, they all had pulmonary complications or were managed with mechanical ventilation. We herein report a case of pneumothorax that developed even though the patient had no pulmonary underlying diseases and had never been managed with mechanical ventilation. In the present case, a lung bulla was found on chest computed tomography during treatment for COVID-19. We concluded that COVID-19 affected the formation of the lung bulla and induced the complication of pneumothorax.