Spontaneous Pneumothorax: A Complication of Coronavirus Disease 2019 (COVID-19) Patients

Abstract

Background At present, the coronavirus disease 2019 (COVID-19) is spreading all over the world. The occurrence of spontaneous pneumothorax in these patients might be higher than the fact, and we should pay high clinical attention to them.

Method Data regarding clinical investigation, laboratory investigation, diagnosis, and treatment measures of 21 COVID-19 patients with spontaneous pneumothorax from January to March of 2020 were collected and analyzed in this study.

Results Seven patients had a history of basic lung diseases. All patients used different methods of oxygen therapy before the occurrence of spontaneous pneumothorax according to the severity of the COVID-19, including 18 patients with ventilator-assisted breathing, 2 patients with bilevel positive airway pressure assisted breathing, and 1 patient with mask oxygen inhalation. All patients were confirmed cases of COVID-19 by chest CT (computed tomography) and virus nucleic acid detection and were found to have spontaneous pneumothorax through physical examination, bedside X-ray, and/or bedside ultrasound. 13 of 21 patients combined with pleural effusion at the same time. All the patients underwent closed thoracic drainage for spontaneous pneumothorax and the pleural effusion, if any. Nine patients died, and 12 patients recovered smoothly.

Conclusion Spontaneous pneumothorax might be an overlooked complication of COVID-19 patients and may be associated with poor prognosis.

Keywords

COVID-19 - spontaneous pneumothorax - closed thoracic drainage - poor prognosis

Publication History

Received: 09 August 2020

Accepted: 22 September 2020

Article published online:
01 December 2020

• References

• 1 Marty AM, Jones MK. The novel coronavirus (SARS-CoV-2) is a one health issue. One Health 2020; 9: 100123
• 2 Cheng AC, Williamson DA. An outbreak of COVID-19 caused by a new coronavirus: what we know so far. Med J Aust 2020; 212 (09) 393-394.e1
• 3 Mahase E. Covid-19: UK records first death, as world's cases exceed 100 000. BMJ 2020; 368: m943
• 4 Sayar A, Kök A, Citak N, Metin M, Büyükkale S, Gürses A. Size of pneumothorax can be a new indication for surgical treatment in primary spontaneous pneumothorax: a prospective study. Ann Thorac Cardiovasc Surg 2014; 20 (03) 192-197
• 5 Coronavirus disease (COVID-2019) situation reports WHO. 2020 https://virusncov.com/coronavirus-cases-statistics
• 6 Swierzy M, Helmig M, Ismail M, Rückert J, Walles T, Neudecker J. Pneumothorax [in German]. Zentralbl Chir 2014; 139 (Suppl. 01) S69-S86 , quiz S87
• 7 Ramos C. Covid-19: the new pathology caused by a coronavirus [in Spanish]. Salud Publica Mex 2020; 62 (02) 225-227
• 8 Tian S, Hu W, Niu L, Liu H, Xu H, Xiao SY. Pulmonary pathology of early-phase 2019 novel coronavirus (COVID-19) pneumonia in two patients with lung cancer. J Thorac Oncol 2020; 15 (05) 700-704
• 9 Xu Z, Shi L, Wang Y. et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med 2020; 8 (04) 420-422
• 10 Liu J, Zheng X, Tong Q. et al. Overlapping and discrete aspects of the pathology and pathogenesis of the emerging human pathogenic coronaviruses SARS-CoV, MERS-CoV, and 2019-nCoV. J Med Virol 2020; 92 (05) 491-494
• 11 Schilling T, Kozian A. Which factors determine prognosis after ventilator-associated pneumothorax in mechanically ventilated patients?. Minerva Anestesiol 2014; 80 (01) 3-4
• 12 Bösmüller H, Traxler S, Bitzer M. et al. The evolution of pulmonary pathology in fatal COVID-19 disease: an autopsy study with clinical correlation. Virchows Arch 2020; 477 (03) 349-357
• 13 Taylor G. Spontaneous pneumothorax. N Engl J Med 2000; 343 (04) 300 , author reply 300–301
• 14 Espigares López MI, Meléndez Leal E, Pernia Romero A, Torres Morera LM. Pneumothorax: immediate ultrasound diagnosis in the critical patient [in Spanish]. Rev Esp Anestesiol Reanim 2018; 65 (09) 541-542
• 15 Hwang TS, Yoon YM, Jung DI, Yeon SC, Lee HC. Usefulness of transthoracic lung ultrasound for the diagnosis of mild pneumothorax. J Vet Sci 2018; 19 (05) 660-666
• 16 Dahmarde H, Parooie F, Salarzaei M. Accuracy of ultrasound in diagnosis of pneumothorax: a comparison between neonates and adults-a systematic review and meta-analysis. Can Respir J 2019; 2019: 5271982
• 17 Chan SS. Emergency bedside ultrasound to detect pneumothorax. Acad Emerg Med 2003; 10 (01) 91-94
• 18 MacLaren G, Fisher D, Brodie D. Preparing for the most critically ill patients with COVID-19: the potential role of extracorporeal membrane oxygenation. JAMA 2020; 323 (13) 1245-1246