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Post COVID-19 pneumo-hematocele: clinical presentation and treatment pathway.
Chávez, Karla Verónica; Pimienta-Ibarra, Adriana Simoneta; Máruquez-González, Horacio; Flores-Garcés, Juan Carlos; Peña-Mirabal, Erica Sagrario; Bolaños-Morales, Francina Valezka.
  • Chávez KV; Surgery Department, Hospital General Ajusco Medio, Mexico City, Mexico.
  • Pimienta-Ibarra AS; Thoracic Surgery, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico.
  • Máruquez-González H; Congenital Heart Diseases Department, Cardiology Hospital, Centro Médico Siglo XXI, Mexico City, Mexico.
  • Flores-Garcés JC; Radiology Department, Hospital General Ajusco Medio, Mexico City, Mexico.
  • Peña-Mirabal ES; Respiratory Pathology, Instituto Nacional de Enfermedades Respiratorias, Calzada de Tlalpan 4502, Sección 16, Tlalpan, 14080, Mexico City, ZP, Mexico.
  • Bolaños-Morales FV; Thoracic Surgery, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico. valezka1976@gmail.com.
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.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumothorax / COVID-19 Type of study: Diagnostic study / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Adult / Female / Humans / Male / Middle aged Language: English Journal: Gen Thorac Cardiovasc Surg Journal subject: Vascular Diseases / Cardiology Year: 2022 Document Type: Article Affiliation country: S11748-022-01771-0

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumothorax / COVID-19 Type of study: Diagnostic study / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Adult / Female / Humans / Male / Middle aged Language: English Journal: Gen Thorac Cardiovasc Surg Journal subject: Vascular Diseases / Cardiology Year: 2022 Document Type: Article Affiliation country: S11748-022-01771-0