Pulmonary infarct in post COVID-19 period, complicated with spontaneous pneumothorax - case report

Introduction: Lung cavitation is a rare finding in COVID-19 patients (1, 2). The aim of this presentation is to report a rare case of cavitary aseptic pulmonary infarct in post-COVID-19 period that is complicated with spontaneous pneumothorax. Case presentation: A 63-year old woman was presented with acute onset of chest pain and on 35th day of COVID19 infection. Chest X-Ray established right-sided total pneumothorax and tube thoracostomy was performed. Due to the persistent air leak computed tomography was performed on the 4th day of thoracostomy. Areas of lung consolidation with a cavitary mass with maximum diameter of 34 mm in the upper lobe were established (fig.1). The woman was scheduled for thoracoscopy and multiple petechiae on the lung surface with necrotic area (bronchopleural fistula) of the upper lobe were established. The procedure was converted to conventional operation with atypical resection of the upper lobe of the lung with removing the necrotic cavitary lesion. Histological examination of the resected lung specimen showed bland cavitary pulmonary infarct. Conclusion(s): This case presents one rare pathological condition in post COVID-19 period - blunt pulmonary cavitary infarct complicated with spontaneous pneumothorax.

[Surgical approach for destructive pneumonia associated with COVID-19]. / Taktika khirurgicheskogo lecheniya destruktivnoi pnevmonii, assotsiirovannoi s infektsiei COVID-19.

There were over 400 million people with COVID-19 pneumonia worldwide and over 12 million in the Russian Federation after 2020. Complicated course of pneumonia with abscesses and gangrene of lungs was observed in 4% of cases. Mortality ranges from 8 to 30%. We report 4 patients with destructive pneumonia following SARS-CoV-2 infection. In one patient, bilateral lung abscesses regressed under conservative treatment. Three patients with bronchopleural fistula underwent staged surgical treatment. Reconstructive surgery included thoracoplasty with muscle flaps. There were no postoperative complications that required redo surgical treatment. We observed no recurrences of purulent-septic process and mortality.

Bronchoscopic Endobronchial Valve Therapy for Persistent Air Leaks in COVID-19 Patients Requiring Veno-Venous Extracorporeal Membrane Oxygenation.

COVID-19 acute respiratory distress syndrome (ARDS) can be associated with extensive lung damage, pneumothorax, pneumomediastinum and, in severe cases, persistent air leaks (PALs) via bronchopleural fistulae (BPF). PALs can impede weaning from invasive ventilation or extracorporeal membrane oxygenation (ECMO). We present a series of patients requiring veno-venous ECMO for COVID-19 ARDS who underwent endobronchial valve (EBV) management of PAL. This is a single-centre retrospective observational study. Data were collated from electronic health records. Patients treated with EBV met the following criteria: ECMO for COVID-19 ARDS; the presence of BPF causing PAL; air leak refractory to conventional management preventing ECMO and ventilator weaning. Between March 2020 and March 2022, 10 out of 152 patients requiring ECMO for COVID-19 developed refractory PALs, which were successfully treated with bronchoscopic EBV placement. The mean age was 38.3 years, 60% were male, and half had no prior co-morbidities. The average duration of air leaks prior to EBV deployment was 18 days. EBV placement resulted in the immediate cessation of air leaks in all patients with no peri-procedural complications. Weaning of ECMO, successful ventilator recruitment and removal of pleural drains were subsequently possible. A total of 80% of patients survived to hospital discharge and follow-up. Two patients died from multi-organ failure unrelated to EBV use. This case series presents the feasibility of EBV placement in severe parenchymal lung disease with PAL in patients requiring ECMO for COVID-19 ARDS and its potential to expedite weaning from both ECMO and mechanical ventilation, recovery from respiratory failure and ICU/hospital discharge.

Fatal Pyopneumothorax in a COVID-19 Patient.

The COVID-19 pandemic has impacted every aspect of our lives since its start in December 2019. Among various COVID-19 complications, pleural complications are also increasingly reported but rarely from Nepal. Here, we presented a case of pyopneumothorax in a 52-year-old male patient referred from another center and admitted to the ICU of Nepal Armed Police Force Hospital with a diagnosis of severe COVID-19 pneumonia in the background of alcohol withdrawal syndrome with delirium tremens and generalized tonic-clonic seizures. He developed a rapid decline in respiratory status with a right-sided pneumothorax and underwent an immediate needle thoracostomy, followed by chest tube insertion. On the sixth day of admission, he had thick yellowish pus in the chest drain (pyopneumothorax), and despite the rigorous efforts in treatment, he died on the 15th day of admission. Though relatively uncommon, clinicians should consider pleural complications like pneumothorax, pleural effusion, pneumomediastinum, and empyema in patients with impaired immune status. In such patients, we should ensure prompt diagnosis with the earliest intervention and rationale use of antibiotics.

FROM ALL LUNG TO ALL AIR: A CASE OF IATROGENIC FUNCTIONAL PNEUMONECTOMY

SESSION TITLE: Pneumothorax, Chylothorax, and Pleural Effusion Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: An alveolopleural fistula (APF) is a pathological communication between the pulmonary alveoli and the pleural space. If pneumothorax persists beyond five days, it is labeled as a prolonged air leak (PAL). Herein, we present a patient with respiratory failure, spontaneous pneumothorax with persistent air leak resulting in functional pneumonectomy despite CTS intervention. CASE PRESENTATION: A 60-year-old female with PMH of diabetes, hypertension was initially admitted for right lower extremity cellulitis. About ten days into the admission, patient started becoming progressively hypoxic and was noted to be saturating 82% on room air with crackles noted bilaterally. A CT angiogram showed findings suggestive of multifocal pneumonia. Covid-19 pneumonia was initially suspected despite negative testing and a course of remdesivir and steroids was administered. All other infectious workup returned negative. Patient's oxygenation requirements worsened over the next two weeks eventually requiring intubation. Bronchoscopy with bronchoalveolar lavage showed growth of stenotrophomonas and patient received a course of trimethoprim-sulfamethoxazole. Patient was subsequently extubated and transitioned to high flow nasal cannula. Two weeks later, she developed acute respiratory deterioration due to a right sided pneumothorax requiring emergent pigtail placement and subsequent intubation. She was noted to have a persistent airleak from the chest tube and imaging showed a persistent pneumothorax with possible malpositioning of the chest tube. Despite repositioning of the previous chest tube and a second chest tube insertion, patient's PAL persisted and she underwent video assisted thoracoscopic surgery (VATS) that showed a large bronchopleural fistula emanating from the right upper and middle lobes requiring stapling and surgical pleurodesis. Bronchoscopy prior to VATS did not show any signs of obstruction. Due to prolonged intubation, she underwent tracheostomy placement followed gradually by chest tube removal when no air leak was appreciated. After the removal of the chest tube, her lung gradually formed multiple bullae with no functional residual lung. Despite this, her respiratory status stabilized and she was discharged to a LTACH. DISCUSSION: The likely cause of APF here was the emergent chest tube insertion. APF and PALs are most seen following pulmonary resection or biopsy but can also be seen following spontaneous pneumothorax or traumatic chest tube insertions. Although an endobronchial valve was entertained, the lung damage was extensive enough to have no change in patient's outcome. CONCLUSIONS: Our case demonstrates a rare but complicated hospital course of a patient where a chest tube insertion resulted in non-resolving APF with PAL despite therapeutic interventions in an unfortunate case of "functional pneumonectomy". Underlying pneumonia may have also contributed to the APF resulting in PAL. Reference #1: 1. Liberman M, Muzikansky A, Wright CD, et al. Incidence and risk factors of persistent air leak after major pulmonary resection and use of chemical pleurodesis. Ann Thorac Surg 2010;89:891. Reference #2: 2. DeCamp MM, Blackstone EH, Naunheim KS, et al. Patient and surgical factors influencing air leak after lung volume reduction surgery: lessons learned from the National Emphysema Treatment Trial. Ann Thorac Surg 2006;82:197. Reference #3: 3. Rivera C, Bernard A, Falcoz PE, et al. Characterization and prediction of prolonged air leak after pulmonary resection: a nationwide study setting up the index of prolonged air leak. Ann Thorac Surg 2011;92:1062. DISCLOSURES: No relevant relationships by Mohammed Halabiya No relevant relationships by Rajapriya Manickam No relevant relationships by Rutwik Patel

Vertical rectus abdominis myocutaneous free flap repair of post-pneumonectomy bronchopleural fistula: a case report.

Background: Bronchopleural fistula (BPF) is a seldom encountered yet serious complication after thoracic surgery, and is often difficult to treat. Large BPFs usually require surgical intervention, and a variety of different surgical reconstruction options have been previously described. This case report presents the first description of a successful vertical rectus abdominis myocutaneous (VRAM) free flap repair of a BPF after pneumonectomy. Case Description: A 46-year-old male with a cough was found to have a right upper lobe lung mass with hilar involvement initially remarkable for epithelioid malignant mesothelioma on biopsy. After neoadjuvant chemotherapy, he underwent right extrapleural pneumonectomy and developed a late right mainstem BPF with associated empyema from adjuvant chemotherapy and COVID-19 pneumonia. He was treated with open Clagett window (OCW) to address the infection and then staged VRAM free flap coverage of the BPF. The patient recovered successfully and has since been able to pursue more demanding activities at home. Conclusions: This case presents the only successful VRAM free flap for a BPF involving the entire right mainstem bronchus at the carina. VRAM free flap repair offers a useful treatment option for BPFs, especially in patients with large pleural cavity defects.

PULMONARY MUCORMYCOSIS AS A COMPLICATION OF SARS COV-2 PNEUMONIA - CASE REPORT AND REVIEW OF LITERATURE

CASE: A 31-year-old woman G4P2204 was admitted with respiratory failure. Her hemoglobin was 9.7 g/dl, D-dimer 1349 ng/mL feu, procalcitonin 0.44 ng/ mL, CRP 91.4 mg/L, normal white count and nasal RT-PCR positive for COVID-19. Chest x-ray showed bilateral patchy airspace opacities. She underwent emergent C-section, was intubated and placed on mechanical ventilation, received Remdesivir, dexamethasone, vancomycin and piperacillintazobactam. On day 11, she developed bilateral pneumothorces and had chest tubes placed. She had new elevation in white blood count (16,000/ul) and inflammatory markers. She was put on extracorporeal membrane oxygenation (ECMO). Computed Tomography ( CT) chest on day 15 showed large multiloculated cavity. She underwent bronchoscopy with bronchoalveolar lavage cultures positive for Mucorales. She had CT abdomen-pelvis, CT head and nasal endoscopy without evidence of invasive disease. She was started on amphotericin B and posaconazole. She had tracheostomy on day 21 and underwent successful ECMO weaning and decannulation on day 35. Chest tubes were removed. Amphotericin B was discontinued. She was discharged on nasal cannula and oral posaconazole and continued to improve. IMPACT/DISCUSSION: There are 6 other cases reported in literature with isolated pulmonary mucormycosis associated with SARS-CoV-2. All of these patients had clinical improvement before deteriorating again with SARS Cov-2 treatment. The timeline of new imaging findings like cavities, changing opacities, pleural effusions or bronchopleural fistula was usually 2 to 3 weeks from diagnosis of SARS-CoV-2 pneumonia. On analysis 5/7 of these patients were not diabetic, 6/7 received steroids, 3/7 received Tocilizumab and 4/7 received Remdesivir. 2 patients received surgical intervention with medical management although it did not change the outcome. Unfortunately despite aggressive medical and surgical treatment, there were poor outcomes. 4/7 patients died, 1/7 was permanently ventilator dependent and 2/7 survived. The diagnosis of isolated pulmonary mucormycosis is challenging. This might be secondary to hesitance of invasive diagnostic tests like bronchoscopy, lack of rapid diagnostic tests and fewer autopsies. Amphotericin B, posaconazole and isavuconazole remain the main treatment options along with surgical debridement of necrotic tissue. The pathology of mucormycosis in COVID-19 has been attributed to impaired T-cell function, impaired phagocytosis and more availability of fungal heme oxygenase which facilitates iron uptake for its metabolism. Glucocorticoids, IL-6 inhibitors and monoclonal antibodies further increase the risk of secondary infections. CONCLUSION: Mucormycosis is a lifethreatening disease with high morbidity and mortality. Based on our case and literature review, it is important to have high index of suspicion for pulmonary mucormycosis in patients who are recently treated with immunosuppressants for SARS-CoV-2 pneumonia and suddenly deteriorate after treatment.

Secondary Pneumothorax Induced by a Bronchopleural Fistula in a Patient With COVID-19 Pneumonia.

COVID-19 is a multi-system disease caused by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2). One of the main highlights of the disease is the development of pneumonia complicated by adult respiratory distress syndrome. While spontaneous pneumothorax has been reported in some patients with COVID-19, bronchopleural fistula has seldom been reported as the primary cause in these cases. We describe the rare case of a young patient who developed a pneumothorax complicating COVID-19 and was found to have a bronchopleural fistula and empyema secondary to Staphylococcus aureus superinfection.

Pulmonary necrosis and bronchopleural fistula in a patient infected with COVID-19: A case report

Objective: Bronchopleural fistula (BPF) is a pathological communication between the bronchial tree and pleural space. BPFs are commonly seen after lung surgery, and are less common in trauma, lung abscess, and radiation therapy. In this study, we describe the clinical course and surgery of a case of pulmonary necrosis and BPF in a patient infected with coronavirus disease 2019 (COVID-19). Case Presentation: The patient was a 54-year-old man with multiple myeloma and end-stage renal disease from the last 8 years. He had a history of coronary artery bypass grafting from the last 3 years. He also suffered from progressive shortness of breath and dry cough since March 2019. Conclusion: The results of this study showed that BPF is one of the most severe complications after thorax surgery, and there is no effective prevention method particularly in this patient who had COVID-19 pneumonia. Therefore, early intervention, especially when diagnosed at an early stage, by strengthening the stump inside the thorax or thoracotomy in the open window may eventually accelerate the closure of the BPF and improve the survival. © 2022 The Author(s).

Post-COVID-19 Pulmonary Infarction Complicated by Spontaneous Pneumothorax: A Case Report.

Pulmonary cavitation is an atypical finding in COVID-19 patients. In this rare case report, a 63-year-old woman (35 days from COVID-19 symptom onset) presented to our emergency department with acute chest pain and shortness of breath. A chest X-ray established right-sided total pneumothorax, hence a tube thoracostomy was performed. Due to a persistent air leak, chest computed tomography was performed, which showed areas of lung consolidation and a cavitary mass in the upper lobe of the right lung. The woman undertook a thoracoscopy, which established multiple petechiae on the lung surface and a bronchopleural fistula of the right lung's upper lobe. The treatment of choice was an atypical lung resection to remove the necrotic cavitary lesion. Histological and microbiological examination of the resected lung specimen showed a bland (aseptic) cavitary pulmonary infarct. Pulmonary infarction is a rare cause of cavitation in COVID-19 patients, nonetheless, something that should be considered in those presenting with respiratory symptoms or complications during or post-COVID-19.

Safe and effective administration of multiple recombinant factors on VA-ECMO via post-oxygenator pigtail during acute massive pulmonary hemorrhage

Introduction: Massive bleeding on extracorporeal membrane oxygenation (ECMO) is associated with multiple coagulation defects, including depletion of coagulation factors and development of acquired von Willebrand syndrome (AVWS). The use of recombinant factors, in particular recombinant activated factor VII (rFVIIa, Novoseven), to treat severe refractory hemorrhage in ECMO has been described. However, the use of multiple recombinant factors has been avoided in large part due to concern for circuit complications and thrombosis. Here, we describe the safe and effective administration of rFVIIa and recombinant von Willebrand factor complex (vWF/ FVIII, Humate-P) via post-oxygenator pigtail catheter on VA-ECMO for the treatment of massive pulmonary hemorrhage. Case Description: A 21-month-old (13.4 kg) girl with a recent history of COVID-19 infection presented to an outside hospital with parainfluenza bronchiolitis resulting in acute refractory hypoxemic respiratory failure (oxygenation index 58), refractory septic shock, and myocardial dysfunction. She was cannulated to VA-ECMO and subsequently diagnosed with necrotizing pneumonia from Pseudomonas and herpes simplex infections. Her course was complicated by a large left-sided pneumatocele and bronchopleural fistula requiring multiple chest tubes. She also had right mainstem bronchus obstruction from necrotic airway debris and complete right lung atelectasis. She was noted to have prolonged episodes of mucosal and cutaneous bleeding (oropharynx, chest tube insertion sites, peripheral IV insertion sites) associated with absent high molecular weight von Willebrand multimers consistent with AVWS. Tranexamic acid infusion was initiated and bivalirudin anticoagulation was discontinued. VA-ECMO flows were escalated to 140-160 ml/kg/min to maintain circuit integrity and meet high patient metabolic demand in the absence of anticoagulation. On ECMO day 26, she underwent bronchoscopy to clear necrotic debris from her airway to assist with lung recruitment. The procedure was notable for mucosal bleeding requiring topical epinephrine and rFVIIa. Post-procedure, she developed acute hemorrhage from her right mainstem bronchus, resulting in significant hemothorax (estimated 950 ml) with mediastinal shift, increased venous pressures, desaturation and decreased ECMO blood flow rate, necessitating massive transfusion of 2,050 ml (150 ml/kg) of packed red blood cells, platelets, plasma and cryoprecipitate. An airway blocker was placed in the mid-trachea to control bleeding. In addition to transfusion of appropriate blood products and continuation of tranexamic acid infusion, she was given both rFVIIa (100mcg/kg) and vWF-FVIII (70 units vWF/kg loading dose on the day of hemorrhage, followed by 40 units vWF/kg every 12 hours for 3 additional doses). Both products were administered over 10 minutes through a post-oxygenator pigtail to allow the product to circulate throughout the patient prior to entering the ECMO circuit. The circuit was closely monitored during administration and no changes to circuit integrity were noted in the subsequent hours while hemostasis was achieved. The ECMO circuit remained without thrombosis for 9 days after the bleeding event. Discussion: Balancing anticoagulation and hemostasis is a central challenge in maintaining ECMO support, especially given the prevalence of acquired coagulopathies such as AVWS. For our patient, AVWS contributed to mucosal bleeding necessitating cessation of anticoagulation and utilization of a high ECMO blood flow strategy to minimize circuit clot burden. This was further complicated by absent native lung function and minimal myocardial function, resulting in complete dependence on ECMO. An acute massive pulmonary hemorrhage was treated with multiple recombinant factors (rFVIIa and vWF/FVIII), that are often avoided on ECMO. To minimize clotting risk to the circuit and to maximize transit of these factors to our patient, we added a post-oxygenator pigtail for administration. While this approach was the result of extreme circumstances, th use of a post-oxygenator pigtail for administration of recombinant factors may represent a viable strategy for refractory hemorrhage while on ECMO.

A case of bilateral spontaneous pneumothorax post COVID -19 infection

Background: Development of spontaneous pneumothorax and pneumomediastinum is one of the complication of COVID-19 viral pneumonitis. This has been described in both mechanically ventilated patients or on non invasive/ high flow nasal cannula oxygen support. The Macklin effect can been proposed as a possible etiology owing to the propensity to the damage to type2 pneumocytes, alveolar rupture secondary to direct alveolar injury. Case: 32 year male, non smoker, non alcoholic with no comorbidities presented to emergency with sudden onset of shortness of breath, left chest pain. HRCT chest done showed left pneumothorax with mediastinal shift. Intercostal drainage tube(ICD) was placed on the left side and patient was stabilised. Patient has had similar complaints one week back for which right sided ICD was placed. Patient had history of COVID-19 infection one month back. He did not require any supplemental oxygen or ventilatory support. Right side ICD was removed 1 week later as there was no air leak. Left side had persistent air leak, with non expanding lung. Patient was put on supplemental oxygen. He was treated with antibiotics, other supplemental oxygen and repeat HRCT chest showed loculated hydropneumothorax with bronchopleural fistula (BPF) on the left side. The patient was discharge with ICD. After improving the general condition, the air leak was surgically corrected with left lobe decortication and BPF closure. Conclusion: COVID 19 infection renders more propensity to damage type 2 pneumocytes. The alveolar rupture is secondary to alveolar injury causing increased tendency for air leak without obviously increased pressures.

Bronchoscopic management of bronchopleural fistula due to COVID-19 a nonsurgical option

Background: COVID-19 has become a dreadful pandemic. One of the important complication is the development of pneumothorax/ pneumomediastinum which gets further complicated by bronchopleural fistula. Case Study: A 44year male patient with severe COVID pneumonia developed Left sided pneumothorax and treated conservatively with ICD and negative suctioning for 2 months and referred to us with persistent pneumothorax with BPF. As patient was unfit for surgery, bronchoscopic management was planned. With flexible bronchoscope, 6F Fogarty balloon was passed and inflated, leak site was identified in left upper lobe upper division. A Watanabe spigot size 5 was deposited at the opening of upper division and manipulated to apical segment. Other small openings were sealed with cyanoacrylate glue and autologous blood patch. After procedure negative suction was reapplied. Repeat Xray showed resolution of pneumothorax. Pleurodesis was done with talc slurry, post pleurodesis showed no pneumothorax and ICD was removed. Patient was discharged, follow up X ray after 4weeks showed no evidence of pneumothorax. Discussion: In most cases of BPF, leak seals after tube thoracostomy, only 3-5% will continue to have persistent leak. For medically inoperable cases, bronchoscopic balloon occlusion of site and subsequent injection with fibrin glue, liquid bioadhesive or blood patch can be done. For large leak;Amplatzer device, stents, spigots, coils are used. Conclusion: Bronchoscopic treatment can work well for a medically inoperable, complicated pneumothorax in COVID-19 disease.

Bronchopleural Fistula and Endobronchial Valve Placement in a Patient With COVID-19 Pneumonia: A Case Report With Literature Review.

Bronchopleural fistulas (BPFs) are associated with high morbidity and mortality. Though most commonly seen after surgical interventions, they are increasingly reported as complications of COVID-19 infection. We present the case of an 86-year-old man with COVID-19 pneumonia and subsequent bronchopleural fistula (BPF) with persistent air leak. Endobronchial valves were placed in apical and posterior segments of the right upper lobe resulting in successful cessation of the air leak. The purpose of the case report and literature review is to help guide the management of persistent air leak.

Experience of using endoscopic bronchial valve in the treatment of complications after pneumonia caused by COVID-19

Objective. The purpose of the study — evaluation of treatment results of patients with c COVID-19 pneumonia complications. Materials and methods. The experience of endoscopic treatment 6 patients with COVID-19 lung complications (5 men and 1 wom-en with age 33—67 years (mean 45.33±13.03 years)). The disease was complicated by the lung destruction with pleural empy-ema and bronchopleural fistula. Endoscopy bronchial valve was used in the treatment of these patients. The mean average duration of pleural drainage insertion before bronchial valve placement was 8±1.46 days (3—12 days). Results. There were no any difficulties with bronchial valve placement. The valves were placed in the intermediate bronchus in three patients, the lower lobe bronchus on the left in two, in the upper lobe bronchus on the left in one patient. In 1 patient, the air leak was stopped during the first day after the intervention, and in 1 patient on the third day. In 4 cases, the leak persist-ed for three days, which required an endoscopic examination with additional bronchial valve insertion in the upper lobe bronchus (on the right — 1 and on the left — 2) or their removal (1 patient) with the installation of larger blockers with a positive re-sult. One patient, 2 days after additional blocking of the upper lobe bronchus of the left lung, underwent replacement of blockers with large ones with a good clinical effect. One patient had multiple procedures for installing and replacing blockers. In all cas-es, it was possible to eliminate air leakage, achieve straightening of the lung tissue and remove drainage from the pleural cavity. Conclusion. Endoscopic bronchial valve placement is effective method of air leakage elimination. It allows improving the patient condition and achieving recovery with COVID-19 pneumonia complication. It’s necessary to take the need for additional bronchial valve placement due to the multilobarity of the lesion and fissure integrity in other lung segments and lobes. © 2022, Media Sphera Publishing Group. All rights reserved.

Bronchopleural Fistula as a Complication in a COVID-19 Patient Managed With Endobronchial Valves.

Bronchopleural fistula (BPF) is associated with high morbidity if left untreated. Although rare, the frequency of BPF in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is becoming recognized in medical literature. We present a case of a 64-year-old male with BPF with persistent air leak due to SARS-CoV-2 pneumonia treated with Spiration Valve System endobronchial valve (EBV). An EBV was placed in the right middle lobe with successful cessation of air leak. In conclusion, the use of EBVs for BPF with persistent air leaks in SARS-CoV-2 patients who are poor surgical candidates is effective and safe.

Bronchopleural fistula and bilateral pneumothorax in a patient with COVID-19.

COVID-19 pneumonia causes several complications that include pneumothorax, hydropneumothorax, empyema, and rarely leads to bronchopleural fistula (BPF). BPF is a communication between the pleural space and the bronchial tree. We report a case of 24 years man with pneumothorax, hydropneumothorax, and BPF that appeared after COVID-19 infection.

Bronchopleural fistula causing persistent pneumothorax in COVID-19 pneumonia patient with no risk factors.

Although pneumothorax is a well-known complication of COVID-19 pneumonia especially in patients requiring mechanical ventilation, bronchopleural fistula causing persistent pneumothorax in sole COVID-19 pneumonia is extremely rare. In this case, we illustrate that bronchopleural fistula can be found in COVID-19 pneumonia, even with no risk factors nor mechanical ventilation administration.

Case Report: COVID-19 Pneumonia Following Left Pneumonectomy for Lung Cancer Complicated by Empyema and Bronchopleural Fistula.

Background: Venous and arterial thromboembolism is commonly reported in critically ill COVID-19 patients, although there are still no definitive statistical data regarding its incidence. Case presentation: we report a case of a patient who fell ill with Covid during hospitalization for a pneumonectomy complicated by empyema and bronchopleural fistula. The patient, despite being cured of COVID, died after 14 days for pulmonary thromboembolism. Conclusion: Our case strengthens the suggestion of adequate thromboprophylaxis in all hospitalized COVID patients and of increasing prophylaxis in critically ill patients even in the absence of randomized studies.