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COVID-19 pneumonia as a risk factor for recurrent pneumothorax

Oscar Jolobe
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DOI: https://doi.org/10.7861/clinmed.Let.22.2.3
Clin Med March 2022
Oscar Jolobe
Retired geriatrician, Manchester, UK
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Editor – The risk factors for primary spontaneous pneumothorax (PSP) and for dystrophic severity score (DSS) now need to include COVID-19-related pneumonia and COVID-19-related pneumatocoele, respectively.1–4

The following case reports form the basis for inclusion of those two parameters.

Ipsilateral recurrent spontaneous pneumothorax in a patient previously on mechanical ventilation2

In this report, a patient previously on a mechanical ventilator for severe COVID-19-related pneumonia experienced two separate episodes of right-sided PSP, 19 days apart. The first episode occurred 28 days post-discharge, and that was 63 days after the diagnosis of COVID-19-related pneumonia. The patient was finally managed by parietal pleurectomy and mechanical abrasion.

Bilateral recurrent spontaneous pneumothorax in a patient previously on mechanical ventilation3

In this report, a patient with COVID-19-related pneumonia presented with cough, breathlessness and diabetic ketoacidosis. Mechanical ventilation was initiated on day 12. While on the ventilator, the patient experienced two separate episodes of right-sided pneumothorax, one of which occurred while an intercostal drain (ICD) was in situ. The patient later experienced two separate episodes of left-sided spontaneous pneumothorax, the first one during mechanical ventilation, and the second one while off the ventilator. The patient was finally managed by pleurodesis.

Recurrent left-sided spontaneous pneumothorax in a patient with bilateral pneumatocoeles4

In this report, a patient with COVID-19-related pneumonia presented with breathlessness, cough and fever. Mechanical ventilation was initiated on day 1. On day 27, chest X-ray revealed two pneumatocoeles in the right lung. On day 28, the patient developed a left-sided spontaneous pneumothorax complicated by bronchopleural fistula. An intercostal drain was inserted. On day 31, computed tomography showed a new right-sided pneumatocoele and also showed pneumomediastinum. On day 54, the day the patient was weaned off the ventilator, a pneumatocoele was noted in the left lung. While off the ventilator, the patient subsequently developed another left-sided pneumothorax.

Comment

These three case reports show that COVID 19-related pneumonia is not only associated with PSP and pneumomediastinum, but it is also a risk factor for recurrent PSP and for PSP-associated pneumatocoele.2–5

  • © Royal College of Physicians 2022. All rights reserved.

References

  1. ↵
    1. Azam A
    , Zahid A, Abdullah Q, et al. Utility of thoracic computed tomography to predict need for early surgery and recurrence after first episode of primary spontaneous pnemumothorax. Clin Med 2021 [Epub ahead of print].
  2. ↵
    1. Kasturi S
    , Muthirevula A, Chinthareddy R, Lingaraju VC. Delayed recurrent spontaneous pneumothorax post-recovery from COVID-19 infection. Indian J Thorac Cardiovasc Surg 2021;37:551–3.
    OpenUrl
  3. ↵
    1. Poudel A
    , Adhikari A, Aryal BB, Poudel Y, Shrestha I. Recurrent pneumothorax in an adult male with bilateral COVID-19 pneumonia. Cureus 2021;13:e17025.
    OpenUrl
  4. ↵
    1. Shah V
    , Brill K, Dhingra G, Kannan S. Delayed recurrent spontaneous pneumothorax in a patient recovering from COVID-19 pneumonia. Korean J Anesthesiol 2021;74:183–5.
    OpenUrlPubMed
  5. ↵
    1. Jolobe OMP
    . Air leaks, pneumatoceles, and air spaces in Covid-19 pneumonia. Am J Emerg Med 2021;46:785.
    OpenUrl
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COVID-19 pneumonia as a risk factor for recurrent pneumothorax
Oscar Jolobe
Clinical Medicine Mar 2022, 22 (2) 188-189; DOI: 10.7861/clinmed.Let.22.2.3

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COVID-19 pneumonia as a risk factor for recurrent pneumothorax
Oscar Jolobe
Clinical Medicine Mar 2022, 22 (2) 188-189; DOI: 10.7861/clinmed.Let.22.2.3
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