BULLOUS/CYSTIC LUNG CHANGES: RARE RADIOGRAPHIC MANIFESTATIONS AFTER COVID-19

ABSTRACT

SESSION TITLE Pathologies of the Post-COVID-19 World SESSION TYPE Rapid Fire Case Reports PRESENTED ON 10/18/2022 1015 am - 1110 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