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

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.

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.