Mediastinal Emphysema, Giant Bulla, and Pneumothorax Developed during the Course of COVID-19 Pneumonia

Abstract

The coronavirus disease 2019 (COVID-19) pneumonia is a recent outbreak in mainland China and has rapidly spread to multiple countries worldwide. Pulmonary parenchymal opacities are often observed during chest radiography. Currently, few cases have reported the complications of severe COVID-19 pneumonia. We report a case where serial follow-up chest computed tomography revealed progression of pulmonary lesions into confluent bilateral consolidation with lower lung predominance, thereby confirming COVID-19 pneumonia. Furthermore, complications such as mediastinal emphysema, giant bulla, and pneumothorax were also observed during the course of the disease.

Keywords: COVID-19; Complication; Coronavirus; Pneumonia; Tomography, X-ray computed.

Fig. 1. CT scans of 38-year-old man who presented with fever.

A. Chest CT scan shows multifocal GGO along bronchovascular bundles and subpleural areas (arrows). B, C. CT scans obtained on day 3 and 7 show rapid progression of GGO and consolidation in both lower lung zones. D. Chest CT scan obtained on day 11 shows bilateral subpleural consolidation and mediastinal emphysema (arrows). E. After serial supportive measures, chest CT scan obtained on day 26 shows improvement of pulmonary lesions and mediastinal emphysema; however, giant bulla (arrow) is noted in left lung. F. Final follow-up CT scan obtained on day 34 shows pneumothorax (arrow) and pleural effusion (arrowhead) in left thorax. GGO = ground-glass opacities

Fig. 2. Coronal and sagittal thin-slice chest CT images.

A, B. Chest CT scans showing pneumomediastinum (arrows) extending up toward neck (arrowheads). C, D. CT scan obtained on day 26 shows giant bulla (5.2 × 4.9 × 15.0 cm) in left lung (arrows) and another bulla (arrowhead). E, F. Final follow-up CT scan obtained on day 34 shows pneumothorax in left thorax (arrows) and bullae (arrowheads).