Tension pneumothorax in a patient with COVID-19

Abstract

A 36-year-old man was brought to the emergency department with suspected COVID-19, following a 3-week history of cough, fevers and shortness of breath, worsening suddenly in the preceding 4 hours. On presentation he was hypoxaemic, with an SpO₂ of 88% on 15 L/min oxygen, tachycardic and had no audible breath sounds on auscultation of the left hemithorax. Local guidelines recommended that the patient should be initiated on continuous positive airway pressure while investigations were awaited, however given the examination findings an emergency portable chest radiograph was performed. The chest radiograph demonstrated a left-sided tension pneumothorax. This was treated with emergency needle decompression, with good effect, followed by chest drain insertion. A repeat chest radiograph demonstrated lung re-expansion, and the patient was admitted to a COVID-19 specific ward for further observation. This case demonstrates tension pneumothorax as a possible complication of suspected COVID-19 and emphasises the importance of thorough history-taking and clinical examination.

Keywords: emergency medicine; infectious diseases; intensive care; respiratory medicine.

Figure 1

Portable chest radiograph demonstrating a left-sided tension pneumothorax, with mediastinal shift and consolidation throughout the right lung.

Figure 2

Point of care lung ultrasound demonstrating confluent B-lines, a finding commonly reported in COVID-19.

Figure 3

Portable chest radiograph demonstrating lung re-expansion and extensive bilateral consolidation in keeping with severe COVID-19.

Figure 4

Thoracic CT demonstrating widespread areas of patchy consolidation, findings consistent with severe COVID-19 infection, with associated bullae.