Title : Tension pneumothorax complicating COVID19 pneumonia
Author : Mohamed Amr, MD
Affiliation : Department of Internal Medicine, Rochester General
Hospital, Rochester, NY.
Corresponding Author : Mohamed Amr, MD
Contact number : 718-764-7202
Affiliation address : 1425 Portland Avenue, Rochester, NY,
14621.
Email address : amrelwagdycardiol@gmail.com
Funding source : none
Conflict of interest : none
Article type : Clinical image
Word count excluding references : 237
Key words : pneumothorax, COVID19
Key clinical message: to know the value of lung imaging in
patient with acute decompensation in the setting of COVID19 and to know
that pneumothorax is currently a well-recognized complication related to
COVID19 pneumonia.
83 year old male with recent admission with COVID19 pneumonia for 10
days, during which he completed treatment with dexamethasone and
remdesivir and was discharged on 3L of oxygen at home which is new, he
is coming back to ED with worsening shortness of breath and hypotension,
his oxygen saturation on presentation was 60%, his exam was notable for
elevated JVD and no air entry over the left lung.
Chest X-ray and CT scan of the lung were done with evidence of large
left pneumothorax in the absence of history of underlying lung disease
together with ground glass opacities in the right lung consistent with
underlying COVID pneumonia.
Chest tube was inserted with improvement of his blood pressure and
resolution of pneumothorax on follow up X-ray but he remained hypoxic
requiring high flow nasal cannula and later BIPAP, later the lung
infiltrates worsened and the picture was consistent with re-worsening of
COVID19 pneumonia, the patient continued to worsen and eventually was
converted to comfort care per his wishes and later died.
The main message from this case is that usually in case of acute
decompensation from COVID19 we think about worsening ARDS, superimposed
bacterial pneumonia or pulmonary embolism, diagnosing PE needs a CT
scan, not all of us think about pneumothorax which is frequently
reported now [1] and just needs a simple chest X-ray which is
reasonable to be considered prior to proceeding to more advanced
imaging.