key: cord-0819902-k08l6ktk
authors: Huis in ‘t Veld, Maite A.; Ten Kortenaar, Suzanne W.; Bodifee, Thomas M.; Stavast, Jeroen; Kessels, Bart
title: Delayed Spontaneous Bilateral Pneumothorax in a Previously Healthy Non-ventilated COVID-19 Patient.
date: 2021-01-22
journal: J Emerg Med
DOI: 10.1016/j.jemermed.2021.01.008
sha: 495e07a0848020f633a2bbda31c3ec24ca4b0f12
doc_id: 819902
cord_uid: k08l6ktk

Background The novel Coronavirus disease (COVID-19) is a recent viral outbreak which has rapidly spread to multiple countries worldwide. Little is known about COVID-19 infection related complications. Case report We report a patient who developed spontaneous bilateral pneumothorax following a recent COVID-19 infection. To our knowledge, this is the first reported case of spontaneous bilateral pneumothorax in a patient with recent confirmed severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) infection without any risk factors for pneumothorax and who had not received positive pressure ventilation. Why should an emergency physician be aware of this? There may be a possible correlation between a recent COVID-19 infection and the development of spontaneous pneumothorax. The diagnosis of spontaneous pneumothorax should be considered in any patient with known or suspected recent COVID-19 infection who presents with new acute symptoms consistent with pneumothorax or sudden clinical deterioration.

Background: The novel Coronavirus disease (COVID-19) is a recent viral outbreak 6 which has rapidly spread to multiple countries worldwide. Little is known about COVID-19 7 infection related complications. 8

Case report : We report a patient who developed spontaneous bilateral pneumothorax 9

following a recent COVID-19 infection. To our knowledge, this is the first reported case of 10 spontaneous bilateral pneumothorax in a patient with recent confirmed severe acute 11 respiratory syndrome Coronavirus-2 (SARS-CoV-2) infection without any risk factors for 12 pneumothorax and who had not received positive pressure ventilation. She had been treated at home with supportive care, consisting of over the counter 40 acetaminophen and a long-acting beta-2-agonist and corticosteroid 41 (formoterol/beclomethasone) inhaler as needed. On presentation, she reported that after an 42 initial recovery period at home, she suddenly experienced a sudden onset progressive 43 shortness of breath and right sided pleuritic chest pain earlier that day. Symptoms started 44 spontaneously, there was no trauma, and no report of a coughing episode preceding 45 symptoms onset. No fever was reported. The patient was tachycardic with a pulse rate of 103 46 beats per minute and tachypneic with a rate of 24 breaths per minute. Her oxygen saturation was 97% on room air. Blood pressure was 122/94 mmHg. Physical examination 48 demonstrated decreased breath sounds on the right side of her chest but was otherwise 49

Laboratory testing demonstrated no abnormalities, with a normal white blood cell 51 count and normal C-reactive protein. A D-dimer was not obtained. A chest X-ray was 52 performed which revealed bilateral pneumothorax, with an apical pneumothorax of the right 53 lung measuring 25mm from the thoracic apex to the lung cupula, as well as an apical left 54 sided pneumothorax measuring 13mm. (Figure 1 ). Fluorescence PCR for SARS-CoV-2 RNA 55 was sent and returned negative. Of note, patient had been in the ED 2 weeks prior and a chest 56 computed tomography (CT) angiography performed on that date revealed subtle sided ground 57 grass opacities in the left lung base, but no other abnormalities were identified. 58

Patient was given supplemental oxygen via a nasal canula. A pleural catheter was 59 inserted in the right pleural space with adequate re-expansion of the lung on chest X-ray. The 60 left sided pneumothorax was left untreated due to its size and patient's mild presentation. She 61 was admitted to our COVID-ward and prescribed analgesia. On day 3 of admission the 62 pleural catheter could be removed, and patient was discharged from hospital in improved 63

Patient returned to clinic for routine follow up, 2 weeks after admission. She was 65 overall recovering well. A repeat chest X-ray showed complete expansion of right lung, with 66 a small, 6 mm remaining apical pneumothorax on the left. She had another repeat X-ray 67 performed 4 weeks later, which revealed complete resolution of the pneumothoraces, and no 68 other abnormalities. A high-resolution CT-scan of the chest was performed 6 weeks later, 69 revealing no abnormalities. 

Developed during the Course of COVID-19 Pneumonia

Epidemiological and clinical characteristics of 99 147 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study

Systematic Review of Imaging Findings in 919 Patients

Emergency Tracheal Intubation in 202 Patients With 153 COVID-19 in Wuhan

Analysis of 92 deceased patients with COVID-19

Tension Pneumothorax in a Patient With 159

Acute respiratory distress syndrome in critically ill 165 patients with severe acute respiratory syndrome

Clinical progression and viral load in a 168 community outbreak of coronavirus-associated SARS pneumonia: a prospective 169 study

Acute Middle East Respiratory Syndrome 172

Temporal Lung Changes Observed on the Chest Radiographs of 55

Experience in Saudi Arabia