Recurrent Hydropneumothorax After COVID-19.

A 60-year-old male with a past medical history of heart failure with reduced ejection fraction, obstructive sleep apnea, atrial flutter, and hypertension initially presented to the emergency department with a chief complaint of shortness of breath. He was diagnosed with COVID-19-induced acute hypoxic respiratory failure. Before his presentation to the emergency department, he was treated with a brief course of hydroxychloroquine, azithromycin, and prednisone. His initial hospitalization was relatively uncomplicated. He then presented back to the emergency department approximately five months later with chief complaints of continued dyspnea and increased work of breathing. On this presentation, he was noted to have a right-sided pneumothorax with a moderate right-sided pleural effusion. The effusion was drained through CT (computed tomography)-guided catheter insertion. Pleural fluid culture and sensitivity were negative, and a cartridge-based nucleic acid amplification test (CBNAAT) was not performed. He was discharged a few days later to home. Over the next several weeks, the patient had recurrent admissions and chest tube placements for unresolving hydropneumothorax. He eventually had a right-sided posterolateral thoracotomy performed. The tissue sample from the thoracotomy was noted to have positive gram staining for fungal hyphae consistent with aspergillosis. This was initially considered a contaminant and not treated with antifungal medication. Unfortunately, after the thoracotomy, the patient continued to have complications including subcutaneous emphysema and recurring hydropneumothoraces. He was taken for another procedure after a repeat CT showed intercostal herniation of the pleura between the fifth and sixth ribs. The herniation was excised, and the pleura was repaired. This pleural tissue was then sent to pathology and noted to have non-caseating granulomas consistent with aspergillosis. At this time, the patient was started on voriconazole. After initiating this medication, the patient's last chest x-ray showed stable findings of his chronic disease process with no new or worsening hydropneumothorax.

Hydropneumothorax Post COVID-19 Infection.

A 32-year-old male presented to the hospital with chief complaints of fever, cough, and breathlessness for the past 4 days and was found to be positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). On arrival at the hospital, the patient required supplemental oxygen. In addition, injection enoxaparin 80 mg subcutaneous twice a day and injection methylprednisolone 40 mg IV twice a day were administered for 10 days. Following this, the patient reported symptomatic improvement and was shifted to the ward with O2 @ 2 L/min through nasal prongs. However, the same evening he complained of right-sided pleuritic chest pain and developed worsening hypoxemia. CT scan of the thorax confirmed the presence of hydropneumothorax with a mediastinal shift to the left side. An intercostal drain (ICD) was placed after shifting him to the intensive care unit (ICU); pleural fluid sent for analysis confirmed the presence of a secondary bacterial infection for which he was treated with appropriate parenteral antibiotics.

Lung decortication for spontaneous hydropneumothorax in post COVID patients: A case series.

Hydropneumothorax is an abnormal collection of air and fluid in the pleural space. As it is a rare complication of COVID-19 pneumonia, we report a case series of spontaneous hydropneumothorax converted to pus collection that was resistant to medical management and treated as decortication and pleurectomy.

A rare case of pulmonary mucormycosis complicated by hydropneumothorax, successfully treated with non-surgical therapies.

Pulmonary mucormycosis (PM) is a rare but rapidly progressive fungal infection associated with high mortality. A review of the literature suggests that pleural effusions and pneumothoraces are uncommon manifestations associated with distant dissemination. Combined surgical interventions and prolonged antifungal therapy constitute the standard first-line management, with significantly poorer outcomes seen in patients managed with medical therapy alone. Here, we report an unusual case of PM complicated by hydropneumothorax in an immunocompromised patient, in whom comorbidities and disease burden precluded surgical debridement. His disease was ultimately treated with intravenous amphotericin B and maintenance posaconazole after adjunctive drainage. This clinical experience highlights the efficacy of antifungal therapy alone in the treatment of potentially fatal cases of PM unsuitable for surgery.

Post-COVID-19 pulmonary cavitation and tension pneumothorax in a non-ventilated patient.

Cavitation and pneumothorax are independently associated with high morbidity and mortality in coronavirus disease-2019 (COVID-19). While spontaneous (non-traumatic) pneumothorax formation has commonly been observed among mechanically ventilated COVID-19 patients, there are few rare reports of COVID-19 associated pneumothorax without any history of barotrauma and other conventional risk factors. Here, we report a unique case of post-COVID-19 cavitation and tension pneumothorax which was further complicated by hydropneumothorax formation in a young patient who suffered severe COVID-19 pneumonia 4 weeks back. As the patient was devoid of any conventional risk factors, we believe that persistent inflammatory alveolar damage even after clinical recovery from COVID-19 played a key role in pulmonary cavitation followed by pneumothorax formation. With prompt clinical and radiological recognition of these fatal, yet treatable complications of COVID-19 pneumonia, the patient was saved and had an uneventful recovery.

Hydropneumothorax With Persistent Air Leak in a Patient With Mild COVID-19 Disease.

COVID-19 is a pandemic viral disease with a catastrophic global impact. The severity of COVID-19 symptoms ranges from very mild to severe and affects mainly the respiratory system. Spontaneous pneumothorax and pleural effusion are rarely seen in spontaneously breathing COVID-19 patients. We herein report a case of a patient with mild COVID-19 disease presenting to the emergency department with hydropneumothorax. Due to persistent air leak, the patient was managed with video-assisted thoracoscopic surgery (VATS) bullectomy and talc pleurodesis. Clinicians managing these patients should be alert to early diagnose this complication.

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.