Diaphragmatic Rupture and Gastric Perforation in a Patient with COVID-19 Pneumonia

Abstract

We describe the case of a young female patient admitted to our emergency department during the Italian COVID-19 epidemic, for fever and dry cough associated with symptoms of gastric reflux over the previous 5 days. Lung ultrasound showed diffuse bilateral B lines with irregular pleural thickening, and consolidation with air bronchogram and slight pleural effusion in the lower left lobe. Chest HRCT and abdominal CT scanning with contrast revealed diaphragmatic rupture with gastric perforation, and atelectasis of the left pulmonary lobe with unilateral pleural effusion, diffuse ground-glass opacities and multiple small consolidations in both lobes. A nasopharyngeal swab for 2019-nCoV was positive. A diagnosis of diaphragmatic rupture and gastric perforation in COVID-19 pneumonia was made. The patient was immediately hospitalized and surgically treated. Treatment for COVID-19 and empiric antibiotic therapy were promptly started.

Learning points: Coronavirus disease (COVID-19) can cause fever, dry cough and acute respiratory failure.Cough can result in several complications, including rupture of the diaphragm and abdominal herniation.CT scanning is the gold standard technique to investigate COVID-19 pneumonia and diaphragmatic rupture.

Keywords: COVID-19; acute chest pain; diaphragmatic rupture; gastric perforation; pneumonia.

Figure 1

Diaphragmatic rupture (Panel A, coronal view) with gastric perforation (Panel B, axial view). Atelectasis of the left pulmonary lobe with pleural effusion (antero-posterior diameter 20 mm); diffuse ground-glass opacities and multiple small consolidations are evident in the remaining pulmonary parenchyma of both lobes (Panel C).