Pneumothorax is air around or outside the lung. We report the largest case series yet described of patients with both these pathologies (including nonventilated patients). The blood investigation results were hemoglobin 13.9 g/dL (normal value is 12‐16 g/dL), WBC 8200/uL (normal value is 3700‐1100/uL), lymphocyte 1060/uL (normal value is 1090‐2990/uL), platelet counts 111 000/uL (normal value is 155 000‐450 000/uL), blood urea 42.98 mg/dL (normal value is 15‐45 mg/dL), serum creatinine 0.52 mg/dL (normal value is 0.57‐1.25 mg/dL), and blood sugar 320.56 mg/dL (normal value is 70‐120 mg/dL). It can be diagnosed with nasopharyngeal swab PCR and chest CT scans. Online Version of Record before inclusion in an issue. Diagnosis is made by chest x-ray. Learn about our remote access options, Cardiothoracic and vascular surgeon, Department of Cardiovascular Surgery, Al‐Sadder Teaching Hospital, Misan Health Directorate, Ministry of Health/Environment, Misan, Iraq, Gynecololgy and obstetric surgery, Department of gynecology, Al‐Sadder Teaching Hospital, Misan Health Directorate, Ministry of Health/Environment, Misan, Iraq. Coronavirus disease 2019 infection may be complicated with pneumothorax after a period of initial symptoms of pneumonia infection. It may also occur with Pneumocystis jirovecii infection in AIDS. It occurs mainly in patients with a history of smoking, COPD, pneumonia, or inpatient on mechanical ventilation with preexisting lung disease. He takes captopril tablet 50 mg once daily for hypertension and amaryl tablet 2 mg/500 mg once daily and glibenclamide tablet 5 mg once daily for diabetes. A collapsed lung occurs when air escapes from the lung. With the exception of one patient, all other patients developed pneumothorax as a late manifestation in their illness; more than 10 days after initial symptom onset in COVID-19. It may result from chest trauma, excess pressure on the lungs or a lung disease, such as chronic obstructive pulmonary disease (COPD), asthma, cystic fibrosis, tuberculosis or whooping cough. The outbreak of the novel coronavirus (COVID-19) that was firstly reported in Wuhan, China, with cases now confirmed in more than 100 countries. However, COVID-19 pneumonia with spontaneous pneumothorax is unknown. eumomediastinum, and pneumothorax (herein collectively termed barotrauma). This was most pronounced when I laid down and particularly at certain angles. Background Recent reports of COVID-19 patients developing pneumothorax mainly correspond to case reports in mechanically-ventilated patients. A 33-year-old woman presented to the hospital with a one-week history of cough, shortness of breath, and myalgia, with no other significant past medical history. From within this case series, all patients who developed spontaneous pneumothorax or pneumo-mediastinum during hospitalization subsequently succumbed to the illness. The pressure causes the lung to give way, at least partly. Use the link below to share a full-text version of this article with your friends and colleagues. Over 10% of patients with PSP report a positive family history of the disease . The patient kept just on mask oxygen without the use of mechanical ventilation and some supported medications. Not only this, but there was an audible squish or … We reported a case of 66-year-old man infected with COVID-19, presenting with fever, cough and myalgia; The patient received supportive and empirical treatment including … The real incidence, clinical characteristics and outcome of spontaneous pneumothorax (SP) as a form of COVID presentation remains to be defined. Pneumothorax (Collapsed Lungs) Pneumothorax, also called a collapsed lung, occurs when air leaks into the space between your lung and chest wall. Lung collapse prevents the lung from expanding when inhaling. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username, Chest radiograph of a patient with COVID‐19 present with a clear line of pneumothorax on the right side of the chest, Chest tube in the right hemithorax through the 5th intercostal space, Chest radiograph that shows fully expanded right lung with parenchymal shadows in both lung field, Chest CT scan shows the correct position of thoracostomy tube and mild pneumothorax with multiple shadows of previous COVID‐19 infection, orcid.org/https://orcid.org/0000-0003-3748-681X, orcid.org/https://orcid.org/0000-0002-0170-1744, I have read and accept the Wiley Online Library Terms and Conditions of Use, Spontaneous pneumothorax and subcutaneous emphysema in COVID‐19 patient: case report, COVID‐19 complicated by spontaneous pneumothorax, Tension pneumothorax in a patient with COVID‐19, COVID‐19 with spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema [published online ahead of print, 2020 Apr 25], A case of spontaneous pneumothorax in covid‐19 pneumonia. The fear of COVID-19 is horrific; I can only imagine what it would do to my already compromised lungs. Common radiological manifestations of COVID-19 include peripheral based ground-glass or consolidative opacities; however, pneumothorax and pneumo-mediastinum are very rare manifestations; even more so within patients not on mechanical ventilation. Coronavirus disease 2019 (COVID-19) infection is a global infection that affects many countries. Informed consent was obtained from the patient to publish the case report. In this case, spontaneous pneumothorax was developed after 21 days of initial COVID‐19 symptoms and after the result of PCR was negative. A pneumothorax occurs when air leaks into the space between your lung and chest wall. We noted many patients with COVID-19 infection who developed pneumothorax, pneumomediastinum, and pneumopericardium, and in some cases, at multiple … Symptoms typically include sudden onset of sharp, one-sided chest pain and shortness of breath. This is like Luke et al, Weiyi et al, and Suphi et al cases, and they have had no smoking and not underwent a mechanical ventilation trial.3-5 In Taha et al study, three cases were reported with pneumothorax and only one case has a smoking history without underlying lung disease in all cases.2. Pneumothorax can be developed with primary or secondary spontaneous causes. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. Pneumothorax and Pneumomediastinum in COVID-19: A Case Series. In the day two postintervention, he was sent for a chest CT scan and shows the correct position of thoracostomy tube and mild pneumothorax with multiple shadows of previous COVID‐19 infection as seen below in Figure 4. In some cases, the cause is unclear. Copyright © 2020 Elsevier B.V. or its licensors or contributors. Over the last few months, the coronavirus disease 2019 (COVID-19) pandemic has created overwhelming challenges for physicians across the world. © 2020 Published by Elsevier Inc. on behalf of Southern Society for Clinical Investigation. The medical name of this condition is pneumothorax. This case demonstrates tension pneumothorax as a possible complication of suspected COVID-19 and emphasises the importance of thorough history-taking and clinical examination. Pneumothorax, pneumomediastinum and subcutaneous emphysema were absorbed by 9 March. My brother and a first cousin each experienced a pneumothorax the although for both, only in one lung. Working off-campus? Common radiological manifestations of COVID-19 include peripheral based ground-glass or consolidative opacities; however, pneumothorax and pneumo-mediastinum are very rare manifestations; even more so within patients not on mechanical ventilation. and you may need to create a new Wiley Online Library account. It is important to maintain an individualised approach to exclude additional underlying pathologies, which can be assisted with good history taking and examination skills. We use cookies to help provide and enhance our service and tailor content and ads. In the 5th postoperative day, the patient sends for a new chest radiograph and shows fully expanded lung without pneumothorax and after clamping of thoracostomy tube for 12 hours so, the tube was removed and the patient discharged home. Neurology Department, College of Medicine, Kufa University, Kufa, Iraq, Misan Radiation Oncology Center, Misan Health Directorate, Ministry of Health/Environment, Misan, Iraq. The authors have no financial disclosures to declare and no conflicts of interest to report. Or it may occur for no obvious reason. The blood pressure was 145/65 mm Hg, heart rate was 99 beats/min, oral temperature was 37.6°C, oxygen saturation was 85%, and respiratory rate was 25 breath/min. Spontaneous pneumothorax and acute pulmonary emboli are important coexisting respiratory pathologies to consider on a background of COVID-19 infection. The pleural cavity is a very thin space between the visceral and parietal pleura of the lungs that usually contains minimal fluid. Then, the patient gradually becomes comfort and kept in an infectious isolated ward. We report the largest case series yet described of patients with both these pathologies that includes non-ventilated patients. Ayam Ali Mohammad, Gynecololgy and obstetric surgery, Department of gynecology, Al‐Sadder Teaching Hospital, Misan Health Directorate, Ministry of Health/Environment, Misan, Iraq. reported a case of spontaneous pneumomediastinum in a patient with COVID-19 who was spontaneously breathing .While the incidence of pneumothorax in … However, Wang et al. It affects many organs especially the lung. He had a history of diabetes mellitus and hypertension without smoking or past surgical history. Chen et al. 19 Therefore, in addition to mechanical ventilation parameters, there are many other factors promoting pneumothorax, such as formation of pulmonary cysts and emphysema-like changes. Coronavirus disease 2019 is a serious infectious disease causing a worldwide pandemic problem which burdens the healthcare services. However, pneumothorax is more common in intubated patients with ARDS than in those without ARDS. It may be atypically present or complicated with pneumothorax. Tube thoracostomy was inserted in right hemithorax under local anesthesia and aseptic technique through the right 5th intercostal space midaxillary line as seen in Figure 2. In the context of the severe respiratory disease associated with COVID-19, it is highly likely that (unless there is a history of retching/vomiting) the pathogenesis of the pneumomediastinum is due to alveolar rupture secondary to barotrauma associated with mechanical ventilation, due to the high PEEP required to maintain adequate oxygenation in these severely compromised patients. HAA‐K: involved in data curation, formal analysis, methodology, validation, and visualization. This is like a Luke flower et al study in which 36‐year‐old man was diagnosed with tension pneumothorax of 4‐hour duration following a 3‐week history of cough, fevers, and dyspnea with positive PCR for COVID‐19 infection.3 Also, it likes Weiyi et al study in which 62‐year‐old man developed features of pneumothorax after about 20 days of admission for COVID‐19 infection.4 While in Burcin et al and Suphi et al case reports, both patients were present with spontaneous pneumothorax in addition to other features of COVID‐19 infection initially.1, 5, Here, there are no identified risk factors for developing a pneumothorax. Since the first cases of COVID-19 have been described, pneumothorax was characterized as a potential, though uncommon, complication. COVID- 19 has become a major pandemic affecting more than 11 million people worldwide. AMF: involved in data curation, formal analysis, methodology design, supervision, validation, visualization, and writing, reviewing, and editing the original draft and provided software. Coronavirus disease 2019 infection is a serious and pandemic global infection spread in many countries including Iraq from December 2019 till now. A pneumothorax is an abnormal collection of air in the pleural space between the lung and the chest wall. Treatment is usually with … Here, the patient presents with pneumothorax after 21 days of initial symptoms of COVID‐19 infection and negative PCR. As we know, it affects mainly the lung due to its access smoothly to cells through angiotensin‐converting enzyme two receptors that are present commonly in type II alveolar cells in the lung.1 In most cases of COVID‐19 infection, the patients may have mild symptoms of fever, dry cough, dyspnea, sore throat, and myalgia. A repeat chest radiograph demonstrated lung re-expansion, and the patient was admitted to a COVID-19 specific ward for further observation. Of the 60 patients with pneumothorax, 58 were laboratory-confirmed COVID-19 infection with two diagnosed based on clinical history and radiology. This case demonstrates tension pneumothorax as a possible complication of suspected COVID-19 and emphasises the importance of thorough history-taking and clinical examination. At New York University Langone Health at the height of the coronavirus disease 2019 (COVID-19) pandemic, 22% of hospitalized patients diagnosed with COVID-19 infection required invasive mechanical ventilation (IMV) . Sec-ond, a lung bulla was detected on chest X-ray and CT after the development of pneumothorax despite not being ob-served on either at the start of COVID-19 treatment. It is easy to diagnose by clinical presentation and chest radiograph. It can be diagnosed with nasopharyngeal swab PCR and chest CT scans. Please check your email for instructions on resetting your password. This air pushes on the outside of your lung and makes it collapse. Here, the patient presents with pneumothorax after 21 days of initial symptoms of COVID-19 infection and negative PCR. reported a case of a patient who developed spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema in a patient who was not on any mechanical ventilation .Similarly, Zhou et al. There are many cases of pneumothorax diagnosed as an initial presentation for COVID‐19 infection,1 but in our case, we report diagnosis and treatment of pneumothorax case after about 21 days of initial symptoms of COVID‐19 infection and after the result of PCR was negative. Yang et al., in an autopsy study consisting of 92 patients, found one case with the same diagnosis 17. We present this case of a young woman with SARS-CoV-2 viral infection resulting in coronavirus 2019 (COVID-19) lung disease complicated by a complex hydropneumothorax, recurrent pneumothorax, and pneumatoceles. The common clinical features of affected patients were fever, dry cough, dyspnea, diarrhea, abdominal pain, sore throat, loss of smell, and myalgia.1 It can be diagnosed by using real‐time reverse transcription‐polymerase chain reaction (rRT‐PCR) from nasopharyngeal swab.1 The patient CT scan of the chest is characteristic for COVID‐19 infection as it may show bilateral ground‐glass appearance with peripheral distribution, and the other features may be present but they are uncommon like lung cavity, pneumomediastinum, subcutaneous emphysema, pleural effusion, pericardial effusion, and pneumothorax.1, 2. Pneumothorax refers to a condition in which there is air in the pleural cavity. It occurs mainly in patients with a history of smoking, COPD, pneumonia, or inpatient on mechanical ventilation with preexisting lung disease. 20, 21 The autopsy of COVID-19 patients showed pulmonary consolidation, fibrosis and lung lobe … 9 described a patient with COVID-19 pneumonia, intubated for respiratory failure, who developed a fatal tension pneumothorax as a result of ventilator-induced lung injury in the setting of severe ARDS. ASA: provided software and involved in writing, reviewing, and editing the original draft. It wasn’t a faster or slower rhythm and it didn’t skip beats; it just felt like it was beating in a more pronounced fashion. Audible squish or … Deliwala et al a first cousin each experienced a (. Barotrauma ) was admitted to a collapsed or punctured lung countries including Iraq from December 2019, patient... 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