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2.
Clin Med (Lond) ; 22(3): 271-275, 2022 05.
Article in English | MEDLINE | ID: covidwho-1856276

ABSTRACT

Pneumomediastinum and pneumothorax are recognised complications encountered in COVID-19 before or during invasive mechanical ventilation (IMV). The clinical course of patients developing pneumomediastinum before IMV is yet to be evaluated.Four-thousand, one-hundred and thirty-one patients hospitalised with COVID-19 over a 12-month period were retrospectively reviewed to evaluate for incidence, clinical characteristics and outcomes. A subgroup analysis was done to identify any clinical traits between survivors and non-survivors. The overall incidence of pneumomediastinum prior to IMV was 0.92% (n=38) and was seen at admission or during non-invasive respiratory support. Thirty-seven per cent had associated pneumothorax most commonly unilateral (right side). The median (interquartile range (IQR)) duration from admission to developing pneumomediastinum was 7 days (3-11) and complete resolution was seen in 53% of patients; median (IQR) duration to resolution was 8 days (4-17). The in-hospital mortality associated with pneumomediastinum in patients with SARS-CoV-2 (PneumoCoV) was 55%. Increasing age (68 ± 12 years vs 56 ± 14 years; p=0.01), higher body mass index (31 ± 5 kg/m2 vs 28 ± 5 kg/m2; p=0.04), lack of resolution of pneumomediastinum (67% vs 24%; p=0.01; odds ratio (OR) 6.5; 95% confidence interval (CI) 1.5-27.5), presence of concurrent pneumothorax (65% vs 14%; p=0.002; OR 11; 95% CI 2.2-53.1) and elevated procalcitonin levels (>0.5 ng/mL; 81% vs 41%; p=0.01; OR 6; 95% CI 1.4-26) were significant features in those who did not survive.The incidence of PneumoCoV, despite being low, is associated with increased mortality. It is a hallmark of moderate to severe disease with multifaceted contributory factors. Both demographic and clinical factors predict survival.


Subject(s)
COVID-19 , Mediastinal Emphysema , Pneumothorax , Aged , Aged, 80 and over , COVID-19/complications , COVID-19/therapy , Humans , Mediastinal Emphysema/epidemiology , Mediastinal Emphysema/etiology , Mediastinal Emphysema/therapy , Middle Aged , Pneumothorax/epidemiology , Pneumothorax/etiology , Pneumothorax/therapy , Respiration, Artificial/adverse effects , Retrospective Studies , SARS-CoV-2
4.
Gen Thorac Cardiovasc Surg ; 70(6): 566-574, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1631031

ABSTRACT

OBJECTIVES: The appearance of characteristic pulmonary lesions has been noted after COVID-19, being described as post-COVID-19 pneumo-hematocele. The aim of this study is to describe the clinical, histopathologic, and imaging features of pneumo-hematocele and to suggest a treatment algorithm for these patients. METHODS: A retrospective study was performed in patients admitted with a diagnosis of SARS-CoV2 infection from March 2020 to September 2021 who presented a pneumo-hematocele on imaging studies. Clinical and demographic variables were recorded, and CT scans were analyzed. A secondary analysis was performed to estimate the risk provided by the pneumo-hematocele diameter of developing pneumothorax. RESULTS: 37 patients were diagnosed with pneumo-hematoceles, 97.3% were males with a median age of 41 ± 13 years and 51% were smokers. The mean diameter of the pneumatocele was 6.3 ± 2.8 cm; they were more common on the subpleural surface and in the inferior lobe. Thirty patients had ruptured pneumo-hematoceles and developed pneumothorax (81.1%); a total of 26 patients required surgery (70.3%). Lesions measuring 5 cm had a high risk of rupture (OR 6.8, CI 95% 1.1-42); those measuring 3 cm were prone to this complication. For each centimeter that the pneumo-hematocele diameter increases, the OR for rupture increases 1.5. CONCLUSIONS: It appears that post-COVID-19 pneumo-hematocele occurs secondary to encapsulation of blood accumulation inside the lung, as a result of micro-capillary bleeding, with partial reabsorption of blood and subsequent air filling. We recommend surgery for patients with pneumo-hematoceles of 5 cm and those with persistent lesions of 3 cm. TRIAL REGISTRATION: Clinical Trial Registration: NCT05067881.


Subject(s)
COVID-19 , Pneumothorax , Adult , COVID-19/complications , Female , Hematocele/diagnosis , Hematocele/etiology , Hematocele/surgery , Hemorrhage , Humans , Male , Middle Aged , Pneumothorax/diagnostic imaging , Pneumothorax/etiology , Pneumothorax/therapy , RNA, Viral , Retrospective Studies , Rupture , SARS-CoV-2
5.
Curr Opin Pulm Med ; 28(1): 62-67, 2022 01 01.
Article in English | MEDLINE | ID: covidwho-1550615

ABSTRACT

PURPOSE OF REVIEW: Pneumothorax is a global health problem. To date, there is still significant variation in the management of pneumothorax. For the past few years, there have been significant developments in the outpatient management of both primary and secondary spontaneous pneumothorax (SSP). We will review the latest evidence for the management of nontraumatic pneumothorax (spontaneous and iatrogenic) to include pneumothorax associated with COVID-19 infection. RECENT FINDINGS: Outpatient management of both primary and SSP may be safe and feasible. SUMMARY: Outpatient management of both primary and SSP should be included in treatment options discussion with patients.


Subject(s)
COVID-19 , Pneumothorax , Humans , Pneumothorax/therapy , SARS-CoV-2
6.
BMJ Case Rep ; 14(11)2021 Nov 19.
Article in English | MEDLINE | ID: covidwho-1526473

ABSTRACT

Patients with SARS-CoV-2 pneumonia can suffer from pneumothorax and persistent air leak (PAL). The pneumothorax occurs with or without pre-existing lung disease. PAL refers to air leak lasting more than 5-7 days and arises due to bronchopleural or alveolopleural fistula. The management of PAL can be challenging as a standard management guideline is lacking. Here we present the case of a 42-year-old smoker with COVID-19 who presented to the hospital with fever, cough, acute left-sided chest pain and shortness of breath. He suffered from a large left-sided pneumothorax requiring immediate chest tube drainage. Unfortunately, the air leak persisted for 13 days before one-way endobronchial valve (EBV) was used with complete resolution of the air leak. We also review the literature regarding other cases of EBV utilisation for PAL in patients with COVID-19.


Subject(s)
COVID-19 , Emphysema , Pneumothorax , Adult , Bronchoscopy , Humans , Male , Pneumothorax/diagnostic imaging , Pneumothorax/etiology , Pneumothorax/therapy , SARS-CoV-2
7.
Infection ; 50(2): 525-529, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1460518

ABSTRACT

PURPOSE: The Coronavirus Disease 2019 (COVID-19) may result not only in acute symptoms such as severe pneumonia, but also in persisting symptoms after months. Here we present a 1 year follow-up of a patient with a secondary tension pneumothorax due to COVID-19 pneumonia. CASE PRESENTATION: In May 2020, a 47-year-old male was admitted to the emergency department with fever, dry cough, and sore throat as well as acute chest pain and shortness of breath. Sputum testing (polymerase chain reaction, PCR) and computed tomography (CT) confirmed infection with the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). Eleven days after discharge, the patient returned to the emergency department with pronounced dyspnoea after coughing. CT showed a right-sided tension pneumothorax, which was relieved by a chest drain (Buelau) via mini open thoracotomy. For a period of 3 months following resolution of the pneumothorax the patient complained of fatigue with mild joint pain and dyspnoea. After 1 year, the patient did not suffer from any persisting symptoms. The pulmonary function and blood parameters were normal, with the exception of slightly increased levels of D-Dimer. The CT scan revealed only discrete ground glass opacities (GGO) and subpleural linear opacities. CONCLUSION: Tension pneumothorax is a rare, severe complication of a SARS-CoV-2 infection but may resolve after treatment without negative long-term sequelae. LEVEL OF EVIDENCE: V.


Subject(s)
COVID-19 , Pneumothorax , COVID-19/complications , Chest Tubes/adverse effects , Follow-Up Studies , Humans , Male , Middle Aged , Pneumothorax/diagnosis , Pneumothorax/etiology , Pneumothorax/therapy , SARS-CoV-2
9.
Monaldi Arch Chest Dis ; 92(1)2021 Sep 28.
Article in English | MEDLINE | ID: covidwho-1444410

ABSTRACT

A 52-year-old man was re-admitted two weeks after recovering from severe COVD-19 following a 3-days history of cough and worsening shortness of breath. The chest radiograph showed a large right-sided pneumothorax. The first attempt at drainage, performed through a large bored tube, failed. Due to the large dimension of the pneumothorax, and the lung condition (extensive consolidation and diffuse bullous dystrophies), the only thoracic surgical approach prospected was a pneumonectomy. Willing to preserve the lung, the pulmonology team attempted a multi-phase medical-oriented strategy based on medical thoracoscopy. Therefore, the patient underwent 5 chest tube insertions, 2 talc pleurodesis, and an intrapleural blood patch. Air leakage resolution was progressively achieved, and the patient became asymptomatic.


Subject(s)
COVID-19 , Pneumothorax , Humans , Male , Middle Aged , Pleurodesis/methods , Pneumothorax/surgery , Pneumothorax/therapy , SARS-CoV-2 , Thoracoscopy
10.
BMC Pulm Med ; 21(1): 293, 2021 Sep 16.
Article in English | MEDLINE | ID: covidwho-1412819

ABSTRACT

BACKGROUND: Re-expansion pulmonary edema is an uncommon complication following drainage of a pneumothorax or pleural effusion. While pneumothorax is noted to complicate COVID-19 patients, no case of COVID-19 developing re-expansion pulmonary edema has been reported. CASE REPRESENTATION: A man in his early 40 s without a smoking history and underlying pulmonary diseases suddenly complained of left chest pain with dyspnea 1 day after being diagnosed with COVID-19. Chest X-ray revealed pneumothorax in the left lung field, and a chest tube was inserted into the intrathoracic space without negative pressure 9 h after the onset of chest pain, resulting in the disappearance of respiratory symptoms; however, 2 h thereafter, dyspnea recurred with lower oxygenation status. Chest X-ray revealed improvement of collapse but extensive infiltration in the expanded lung. Therefore, the patient was diagnosed with re-expansion pulmonary edema, and his dyspnea and oxygenation status gradually improved without any intervention, such as steroid administration. Abnormal lung images also gradually improved within several days. CONCLUSIONS: This case highlights the rare presentation of re-expansion pulmonary edema following pneumothorax drainage in a patient with COVID-19, which recovered without requiring treatment for viral pneumonia. Differentiating re-expansion pulmonary edema from viral pneumonia is crucial to prevent unnecessary medication for COVID-19 pneumonia and pneumothorax.


Subject(s)
COVID-19/complications , Chest Tubes , Pneumothorax/therapy , Pulmonary Edema/etiology , Adult , COVID-19/diagnosis , Humans , Male , Radiography, Thoracic , SARS-CoV-2/isolation & purification , Tomography, X-Ray Computed
11.
Monaldi Arch Chest Dis ; 92(1)2021 Sep 14.
Article in English | MEDLINE | ID: covidwho-1410354

ABSTRACT

Spontaneous pneumothorax (SP) is a rare complication of COVID-19 pneumonia; it affects both intubated and non-intubated patients. The pathogenesis includes barotrauma and pneumatocele formation. In the following article, we present case series of 18 patients with COVID-19 associated pneumothorax - a detailed demographic and clinical analysis were performed. The study revealed that men were more affected than women, especially above the age of 55 years; whilst, the distribution of intubated patients and those with spontaneous breathing were equal. Importantly, tube thoracostomy was the preferred method of treatment. The lethal outcome was observed in all patients on mechanical ventilation, due to the severe course of the underlying disease. The occurrence of pneumothorax in patients with COVID-19 is associated with poorer outcome of the disease, especially in those placed on mechanical ventilation.


Subject(s)
COVID-19 , Pneumothorax , COVID-19/complications , Female , Humans , Male , Middle Aged , Pneumothorax/etiology , Pneumothorax/therapy , Respiration, Artificial/adverse effects , Retrospective Studies , SARS-CoV-2
13.
Wien Med Wochenschr ; 172(3-4): 84-89, 2022 Mar.
Article in German | MEDLINE | ID: covidwho-1353705

ABSTRACT

The new coronavirus (SARS-CoV-2) that arose in 2019 causes a wide spectrum of symptoms and different courses of disease. Pneumothorax, pneumomediastinum and soft tissue emphysema are rare complications in patients with pulmonary involvement. They are the sequelae of severe, virus-induced structural changes of the pulmonary architecture. High pressure artificial ventilation aggravates the problem. Hence pneumothorax and ectopic air in soft tissues are indicators of extensive pulmonary damage. Therefore, efforts should be made to treat even very small or multiply recurrent pneumothorax by drainage procedures.


Subject(s)
COVID-19 , Mediastinal Emphysema , Pneumothorax , Subcutaneous Emphysema , COVID-19/complications , Humans , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/etiology , Mediastinal Emphysema/therapy , Pneumothorax/diagnostic imaging , Pneumothorax/etiology , Pneumothorax/therapy , SARS-CoV-2 , Subcutaneous Emphysema/diagnostic imaging , Subcutaneous Emphysema/etiology , Subcutaneous Emphysema/therapy
14.
Asian Cardiovasc Thorac Ann ; 30(2): 237-244, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1305542

ABSTRACT

INTRODUCTION: There are various reports of air leaks with coronavirus disease 2019 (COVID-19). We undertook a systematic review of all published case reports and series to analyse the types of air leaks in COVID-19 and their outcomes. METHODS: The literature search from PubMed, Science Direct, and Google Scholar databases was performed from the start of the pandemic till 31 March 2021. The inclusion criteria were case reports or series on (1) laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, (2) with the individual patient details, and (3) reported diagnosis of one or more air leak syndrome (pneumothorax, subcutaneous emphysema, pneumomediastinum, pneumoperitoneum, pneumopericardium). RESULTS: A total of 105 studies with 188 patients were included in the final analysis. The median age was 56.02 (SD 15.53) years, 80% males, 11% had previous respiratory disease, and 8% were smokers. Severe or critical COVID-19 was present in 50.6% of the patients. Pneumothorax (68%) was the most common type of air leak. Most patients (56.7%) required intervention with lower mortality (29.1% vs. 44.1%, p = 0.07) and intercostal drain (95.9%) was the preferred interventional management. More than half of the patients developed air leak on spontaneous breathing. The mortality was significantly higher in patients who developed air leak with positive pressure ventilation (49%, p < 0.001) and required escalation of respiratory support (39%, p = 0.006). CONCLUSION: Air leak in COVID-19 can occur spontaneously without positive pressure ventilation, higher transpulmonary pressures, and other risk factors like previous respiratory disease or smoking. The mortality is significantly higher if associated with positive pressure ventilation and escalation of respiratory support.


Subject(s)
COVID-19 , Mediastinal Emphysema , Pneumothorax , Female , Humans , Male , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/etiology , Mediastinal Emphysema/therapy , Middle Aged , Pneumothorax/etiology , Pneumothorax/therapy , SARS-CoV-2 , Treatment Outcome
15.
Heart Lung ; 50(5): 599-608, 2021.
Article in English | MEDLINE | ID: covidwho-1213255

ABSTRACT

BACKGROUND: Pneumothorax has been frequently described as a complication of COVID-19 infections. OBJECTIVE: In this systematic review, we describe the incidence, clinical characteristics, and outcomes of COVID-19-related pneumothorax. METHODS: Studies were identified through MEDLINE, Pubmed, and Google Scholar databases using keywords of "COVID-19," "SARS-CoV-2," "pneumothorax," "pneumomediastinum," and "barotrauma" from January 1st, 2020 to January 30th, 2021. RESULTS: Among the nine observational studies, the incidence of pneumothorax is low at 0.3% in hospitalized COVID-19 patients. However, the incidence of pneumothorax increases to 12.8-23.8% in those requiring invasive mechanical ventilation (IMV) with a high mortality rate up to 100%. COVID-19-related pneumothorax tends to be unilateral and right-sided. Age, pre-existing lung diseases, and active smoking status are not shown to be risk factors. The time to pneumothorax diagnosis is around 9.0-19.6 days from admission and 5.4 days after IMV initiation. COVID-19-related pneumothoraces are associated with prolonged hospitalization, increased likelihood of ICU admission and death, especially among the elderly. CONCLUSION: COVID-19-related pneumothorax likely signify greater disease severity. With the high variability of COVID-19-related pneumothorax incidence described, a well-designed study is required to better assess the significance of COVID-19-related pneumothorax.


Subject(s)
COVID-19 , Mediastinal Emphysema , Pneumothorax , Aged , Humans , Incidence , Pneumothorax/epidemiology , Pneumothorax/etiology , Pneumothorax/therapy , Respiration, Artificial/adverse effects , SARS-CoV-2
17.
Int J Environ Res Public Health ; 18(4)2021 02 23.
Article in English | MEDLINE | ID: covidwho-1100117

ABSTRACT

The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a global pandemic and a burden to global health at the turn of 2019 and 2020. No targeted treatment for COVID-19 infection has been identified so far, thus supportive treatment, invasive and non-invasive oxygen support, and corticosteroids remain a common therapy. High-flow nasal cannula (HFNC), a non-invasive oxygen support method, has become a prominent treatment option for respiratory failure during the SARS-CoV-2 pandemic. HFNC reduces the anatomic dead space and increases positive end-expiratory pressure (PEEP), allowing higher concentrations and higher flow of oxygen. Some studies suggest positive effects of HFNC on mortality and avoidance of intubation. Spontaneous pneumothorax has been observed in patients suffering from SARS-CoV-2 pneumonia. Although the viral infection itself contributes to its development, higher PEEP generated by both HFNC and mechanical ventilation is another risk factor for increased alveoli damage and air-leak. Herein, we present three cases of patients with no previous history of lung diseases who were diagnosed with COVID-19 viral pneumonia. All of them were supported with HFNC, and all of them presented spontaneous pneumothorax.


Subject(s)
COVID-19 , Oxygen Inhalation Therapy/adverse effects , Pneumothorax , Respiratory Insufficiency , Aged, 80 and over , Cannula , Humans , Intensive Care Units , Male , Middle Aged , Pneumothorax/epidemiology , Pneumothorax/etiology , Pneumothorax/therapy , Respiratory Insufficiency/therapy
18.
BMJ Case Rep ; 14(1)2021 Jan 18.
Article in English | MEDLINE | ID: covidwho-1066837

ABSTRACT

A previously healthy 37-year-old man presented with fevers and myalgias for a week with a minimal dry cough. Initial SARS-CoV-2 nasopharyngeal testing was negative, but in light of high community prevalence, he was diagnosed with COVID-19, treated with supportive care and self-quarantined at home. Three days after resolution of all symptoms, he developed sudden onset chest pain. Chest imaging revealed a large right-sided pneumothorax and patchy subpleural ground glass opacities. IgM and IgG antibodies for SARS-CoV-2 were positive. His pneumothorax resolved after placement of a small-bore chest tube, which was removed after 2 days.This case demonstrates that patients with COVID-19 can develop a significant pulmonary complication, a large pneumothorax, despite only minimal lower respiratory tract symptoms and after resolution of the original illness. Medical professionals should consider development of a pneumothorax in patients who have recovered from COVID-19 and present with new respiratory symptoms.


Subject(s)
COVID-19/complications , Convalescence , Pneumothorax/etiology , Adult , COVID-19/physiopathology , COVID-19 Serological Testing , Chest Pain/physiopathology , Chest Tubes , Cough/physiopathology , Dyspnea/physiopathology , Fever/physiopathology , Humans , Male , Myalgia/physiopathology , Pneumothorax/diagnostic imaging , Pneumothorax/physiopathology , Pneumothorax/therapy , Radiography, Thoracic , SARS-CoV-2 , Severity of Illness Index , Thoracostomy , Tomography, X-Ray Computed
20.
Am J Emerg Med ; 39: 258.e1-258.e3, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1023407

ABSTRACT

In the coronavirus disease 2019 (COVID-19) era, the presence of acute respiratory failure is generally associated with acute respiratory distress syndrome; however, it is essential to consider other differential diagnoses that require different, and urgent, therapeutic approaches. Herein we describe a COVID-19 case complicated with bilateral spontaneous pneumothorax. A previously healthy 45-year-old man was admitted to our emergency department with sudden-onset chest pain and progressive shortness of breath 17 days after diagnosis with uncomplicated COVID-19 infection. He was tachypneic and presented severe hypoxemia (75% percutaneous oxygen saturation). Breath sounds were diminished bilaterally on auscultation. A chest X-ray revealed the presence of a large bilateral pneumothorax. A thoracic computed tomography (CT) scan confirmed the large bilateral pneumothorax, with findings consistent with severe COVID-19 infection. Chest tubes were inserted, with immediate clinical improvement. Follow-up chest CT scan revealed resolution of bilateral pneumothorax, reduction of parenchymal consolidation, and formation of large bilateral pneumatoceles. The patient remained under observation and was then discharged home. Bilateral spontaneous pneumothorax is a very rare, potentially life-threatening complication in patients with COVID-19. This case highlights the importance of recognizing this complication early to prevent potentially fatal consequences.


Subject(s)
COVID-19/complications , COVID-19/diagnosis , Pneumothorax/virology , Chest Tubes , Dyspnea/etiology , Humans , Male , Middle Aged , Pneumothorax/diagnostic imaging , Pneumothorax/therapy , Radiography, Thoracic , Tomography, X-Ray Computed
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