A Current and Common Cause of Secondary Spontaneous Pneumothorax: Covid- 19 Pneumonia

Abstract

This study evaluated cases of spontaneous pneumothorax developing secondary to SARS-CoV-2 pneumonia. Sixteen cases presenting to our hospital due to spontaneous pneumothorax developing secondary to SARS-CoV-2 pneumonia between March 2020 and February 2020 were evaluated retrospectively. Ten patients (62.5%) were men, and six (37.5%) were women, with a mean age of 68 ± 20.3 years (range 18 - 90 years). Pneumothorax was in the right hemithorax in 11 cases (68.75%), in the left hemithorax in two (12.5%), and bilateral in three (17.75%). Pneumothorax developed during active SARS-CoV-2 pneumonia in all 16 cases (100%). No pneumothorax was detected following the healing of SARS-CoV-2 infection. Pneumothorax was observed while patients were not intubated in 15 cases (93.75%), but pneumothorax developed during mechanical ventilation in one case (6.25%). Tube thoracostomy was performed on all patients in treatment. Air leakage from the tube was observed in 14 cases (87.5%). The mean duration of tube thoracostomy was 18.3 ± 20.1 days (range 1 - 81 days). Pneumothorax resolved after treatment in seven cases (43.75%), while mortality occurred in nine (56.25%). Pneumothorax recurred after treatment in one case (6.25%). Pneumothorax is widely seen in the active period or after healing in cases infected with COVID-19. Aggressive treatment is generally required for this clinical manifestation with high mortality.

Keywords

• SARS-CoV-2
• Pneumonia
• Pneumothorax;
• Management

References

1. 1. Onuki T, Ueda S, Yamaoka M, Sekiya Y, Yamada H, Kawakami N, et al. Primary and Secondary Spontaneous Pneumothorax: Prevalence, Clinical Features, and In-Hospital Mortality. Can Respir J. 2017;2017:6014967.
2. 2. Türkyılmaz A, Erdem AF, Aydın Y, Çinici Ö, Eroğlu A. Treatment of Secondary Spontaneous Pneumothorax: 100-Patient Experience. The Eurasian Journal of Medicine 2007; 39: 97-102. (Turkish).
3. 3. Elhakim TS, Abdul HS, Pelaez Romero C, Rodriguez-Fuentes Y. Spontaneous pneumomediastinum, pneumothorax and subcutaneous emphysema in COVID-19 pneumonia: a rare case and literature review. BMJ Case Rep. 2020;13:e239489.
4. 4. Quincho-Lopez A, Quincho-Lopez DL, Hurtado-Medina FD. Case Report: Pneumothorax and Pneumomediastinum as Uncommon Complications of COVID-19 Pneumonia-Literature Review. Am J Trop Med Hyg. 2020;103:1170-1176.
5. 5. Alhakeem A, Khan MM, Al Soub H, Yousaf Z. Case Report: COVID-19-Associated Bilateral Spontaneous Pneumothorax-A Literature Review. Am J Trop Med Hyg. 2020;103:1162-1165.
6. 6. Miró Ò, Llorens P, Jiménez S, Piñera P, Burillo-Putze G, Martín A, et al. Frequency, Risk Factors, Clinical Characteristics, and Outcomes of Spontaneous Pneumothorax in Patients With Coronavirus Disease 2019: A Case-Control, Emergency Medicine-Based Multicenter Study. Chest. 2021;159:1241-1255.
7. 7. Rafiee MJ, Babaki Fard F, Samimi K, Rasti H, Pressacco J. Spontaneous pneumothorax and pneumomediastinum as a rare complication of COVID-19 pneumonia: Report of 6 cases. Radiol Case Rep. 2021;16:687-692.
8. 8. Akçay Ş, Özlü T, Yılmaz A. Radiological approaches to COVID-19 pneumonia. Turk J Med Sci. 2020;50:604-610.

9. 9. 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;215:87-93.
10. 10. Vahidirad A, Jangjoo A, Ghelichli M, Arian Nia A, Zandbaf T. Tension pneumothorax in patient with COVID-19 infection. Radiol Case Rep. 2021;16:358-360.
11. 11. Zantah M, Dominguez Castillo E, Townsend R, Dikengil F, Criner GJ. Pneumothorax in COVID-19 disease- incidence and clinical characteristics. Respir Res. 2020;21:236.
12. 12. Al-Shokri SD, Ahmed AOE, Saleh AO, AbouKamar M, Ahmed K, Mohamed MFH. Case Report: COVID-19-Related Pneumothorax-Case Series Highlighting a Significant Complication. Am J Trop Med Hyg. 2020;103:1166-1169.
13. 13. Akdogan RE, Mohammed T, Syeda A, Jiwa N, Ibrahim O, Mutneja R. Pneumothorax in Mechanically Ventilated Patients with COVID-19 Infection. Case Rep Crit Care. 2021;2021:6657533.
14. 14. Özdemir S, Bilgi DÖ, Köse S, Oya G. Pneumothorax in patients with coronavirus disease 2019 pneumonia with invasive mechanical ventilation. Interact Cardiovasc Thorac Surg. 2020 Nov 19:ivaa287. doi: 10.1093/icvts/ivaa287. Epub ahead of print.
15. 15. Talan L, Şaşal Solmaz FG, Ercan U, Akdemir Kalkan İ, Yenigün BM, Yüksel C, Altıntaş ND. COVID-19 pneumonia and pneumothorax: case series. Tuberk Toraks. 2020;68:437-443.
16. 16. Kasturi S, Muthirevula A, Chinthareddy RR, Lingaraju VC. Delayed recurrent spontaneous pneumothorax post-recovery from COVID-19 infection. Indian J Thorac Cardiovasc Surg. 2021:1-3. doi: 10.1007/s12055-021-01145-w. Epub ahead of print.
17. 17. Martinelli AW, Ingle T, Newman J, Nadeem I, Jackson K, Lane ND, et al. COVID-19 and pneumothorax: a multicentre retrospective case series. Eur Respir J. 2020;56:2002697.
18. 18. Aiolfi A, Biraghi T, Montisci A, Bonitta G, Micheletto G, Donatelli F, et al. Management of Persistent Pneumothorax With Thoracoscopy and Bleb Resection in COVID-19 Patients. Ann Thorac Surg. 2020;110:e413-e415.