Pneumatocele as rare thoracic complication after recovering COVID-19 pneumonitis- a case series including literature review

ABSTRACT

Outbreak of coronavirus disease 2019 (COVID-19) with its overwhelming morbidity and mortality has created a significant challenge for health systems worldwide. Although peripheral ground-glass opacities are the most frequent radiologic feature of COVID-19 described in the literature, long term rare complications such as cavitations, pneumatocele, pneumothorax, empyema or hemothorax are occasionally reported. Pneumatoceles are defined as thin-walled air-filled cyst in the lung interstitium, caused by ischemia related damage of alveolar wall and check valve mechanism, which lead to air trapping. We describe a case series of eight patients, diagnosed with COVID-19, confirmed by the reverse transcription polymerase chain reaction (RT-PCR) for SARS-CoV-2 of nasopharyngeal swab and complicated with pneumatocele and pneumothorax, the largest group at present. Among these patients seven were males, only one had a history of a previous lung disease, six had a smoking history. One out of these eight patients suffered from acute respiratory distress syndrome (ARDS) requiring mechanical ventilation. During the hospitalization three patients received surgical intervention with resection of pneumatocele, others were successfully treated conservatively with antibiotic therapy. Reason for surgical intervention included non-resolving pneumothorax, superinfection of pneumatocele non responding to antibiotic therapy and hemothorax. According to our study not every pneumatocele requires surgical intervention. Conservative management or surgical approach in those complications should be decided individually.