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Case Reports
. 2020 Dec;48(6):941-944.
doi: 10.1007/s15010-020-01457-w. Epub 2020 Jun 18.

Secondary tension pneumothorax in a COVID-19 pneumonia patient: a case report

Judith E Spiro  1 , Snezana Sisovic  2 , Ben Ockert  3 , Wolfgang Böcker  3 , Georg Siebenbürger  4
Affiliations
Case Reports

Secondary tension pneumothorax in a COVID-19 pneumonia patient: a case report

Judith E Spiro et al. Infection. 2020 Dec.

Abstract

Purpose: Especially in elderly and multimorbid patients, Coronavirus Disease 2019 (COVID-19) may result in severe pneumonia and secondary complications. Recent studies showed pneumothorax in rare cases, but tension pneumothorax has only been reported once.

Case presentation: A 47-year-old male was admitted to the emergency department with fever, dry cough and sore throat for the last 14 days as well as acute stenocardia and shortage of breath. Sputum testing (polymerase chain reaction, PCR) confirmed SARS-CoV-2 infection. Initial computed tomography (CT) showed bipulmonary groundglass opacities and consolidations with peripheral distribution. Hospitalization with supportive therapy (azithromycin) as well as non-invasive oxygenation led to a stabilization of the patient. After 5 days, sputum testing was negative and IgA/IgG antibody titres were positive for SARS-CoV-2. The patient was discharged after 7 days. On the 11th day, the patient realized pronounced dyspnoea after coughing and presented to the emergency department again. CT showed a right-sided tension pneumothorax, which was relieved by a chest drain (Buelau) via mini open thoracotomy. Negative pressure therapy resulted in regression of the pneumothorax and the patient was discharged after 9 days of treatment.

Conclusion: Treating physicians should be aware that COVID-19 patients might develop severe secondary pulmonary complications such as acute tension pneumothorax.

Level of evidence: V.

Keywords: COVID-19; Multidetector computed tomography; Pneumonia; Pneumothorax; Viral infections.

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Conflict of interest statement

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

Figures

Fig. 1
Fig. 1
Axial CT images obtained with intravenous contrast at second admission show a right-sided tension pneumothorax with mediastinal shift to the left and right heart compression (a). Unenhanced axial CT images obtained 8 days after second admission show remission of tension pneumothorax, new soft tissue emphysema of the right chest wall and mild pneumomediastinum (b). Bilateral GGO and consolidations with peripheral distribution on both images are signs of COVID-19 pneumonia. CT, computed tomography; GGO, ground glass opacities
Fig. 2
Fig. 2
Timeline of the patient history from first admission to second discharge. COVID-19, Coronavirus Disease 2019. CT, computed tomography. GGO, ground glass opacities. PCR, polymerase chain reaction. RNA, ribonucleic acid. SARS-CoV-2, severe acute respiratory syndrome coronavirus 2
See this image and copyright information in PMC

Comment in

References

    1. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382:727–733. doi: 10.1056/NEJMoa2001017. - DOI - PMC - PubMed
    1. Salzberger B, Gluck T, Ehrenstein B. Successful containment of COVID-19: the WHO-Report on the COVID-19 outbreak in China. Infection. 2020;48:151–153. doi: 10.1007/s15010-020-01409-4. - DOI - PMC - PubMed
    1. Wu J, Wu X, Zeng W, Guo D, Fang Z, Chen L, et al. Chest CT findings in patients with coronavirus disease 2019 and its relationship with clinical features. Invest Radiol. 2020;55:257–261. doi: 10.1097/RLI.0000000000000670. - DOI - PMC - PubMed
    1. Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A. Coronavirus Disease 2019 (COVID-19): a systematic review of imaging findings in 919 patients. AJR Am J Roentgenol. 2020 doi: 10.2214/AJR.20.23034. - DOI - PubMed
    1. Ye G, Pan Z, Pan Y, Deng Q, Chen L, Li J, et al. Clinical characteristics of severe acute respiratory syndrome coronavirus 2 reactivation. J Infect. 2020 doi: 10.1016/j.jinf.2020.03.001. - DOI - PMC - PubMed

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