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.
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