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Pneumothorax in a COVID-19 Patient Receiving Long-Term Mechanical Ventilation

A 58-year-old woman reported to the clinic while being followed up after a diagnosis of COVID-19. She was administered favipiravir, dexamethasone, moxifloxacin, and a carbapenem. On the sixth day of treatment, she was admitted to the intensive care unit and intubated due to an oxygen saturation of 80-85% with an oxygen mask and the development of dyspnea and tachypnea. She was followed up in the intensive care unit for a month while mechanical ventilation, and she had worsening respiratory acidosis and elevated airway pressure. The general condition of the patient deteriorated, and chest CT showed left pneumothorax. In addition, there were bronchial enlargements, consolidated areas, and pleural effusion accompanied by diffuse ground-glass opacity in the thoracic CT scan (Figure 1, arrow).

FIGURE 1:
Axial and coronal unenhanced chest computed tomography. Pneumothorax (arrows), multiple ground-glass opacities and consolidations (arrowheads), in both lung fields.

Pneumothorax and pneumomediastinum are relatively common complications in patients with extensive alveolar damage requiring mechanical ventilation11. Belletti A, Palumbo D, Zangrillo A, Fominskiy EV, Franchini S, Dell'Acqua A, et al. COVIDBioB Study Group. Predictors of Pneumothorax/Pneumomediastinum in Mechanically Ventilated COVID-19 Patients. J Cardiothorac Vasc Anesth. 2021;S1053-0770(21)00103-8.. In lung areas exposed to high pressure during mechanical ventilation, alveolar rupture may develop and cause pneumothorax22. Mohammadi Tofigh A, Shojaei SP, Zebarjadi Bagherpour J, Mirkheshti A, Tahmasebi H. Pneumothorax as an Ominous Side Effect in COVID-19 Patients under Mechanical Ventilation: Report of Seven Patients. J Cell Mol Anesth. 2020;5(3):202-5.. Cases of spontaneous pneumothorax have also been reported in patients who are not intubated with COVID-1933. Martinelli AW, Ingle T, Newman J, Nadeem I, Jackson K, Lane ND. COVID-19 and pneumothorax: a multicentre retrospective case series. Eur Respir J. 2020;56(5):2002697.. According to one hypothesis, cystic and fibrotic changes in the lung parenchyma during the early stages of COVID-19 may be the cause of the predisposition to pneumothorax33. Martinelli AW, Ingle T, Newman J, Nadeem I, Jackson K, Lane ND. COVID-19 and pneumothorax: a multicentre retrospective case series. Eur Respir J. 2020;56(5):2002697..

ACKNOWLEDGMENTS

Not Applicable.

REFERENCES

  • 1
    Belletti A, Palumbo D, Zangrillo A, Fominskiy EV, Franchini S, Dell'Acqua A, et al. COVIDBioB Study Group. Predictors of Pneumothorax/Pneumomediastinum in Mechanically Ventilated COVID-19 Patients. J Cardiothorac Vasc Anesth. 2021;S1053-0770(21)00103-8.
  • 2
    Mohammadi Tofigh A, Shojaei SP, Zebarjadi Bagherpour J, Mirkheshti A, Tahmasebi H. Pneumothorax as an Ominous Side Effect in COVID-19 Patients under Mechanical Ventilation: Report of Seven Patients. J Cell Mol Anesth. 2020;5(3):202-5.
  • 3
    Martinelli AW, Ingle T, Newman J, Nadeem I, Jackson K, Lane ND. COVID-19 and pneumothorax: a multicentre retrospective case series. Eur Respir J. 2020;56(5):2002697.
  • Financial Support: The authors declare that no grants or funds were received.

Publication Dates

  • Publication in this collection
    23 July 2021
  • Date of issue
    2021

History

  • Received
    15 June 2021
  • Accepted
    24 June 2021
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