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.