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Schaap JP, Zuluaga Fernandez ME, Houtkooper A, Endert EL, van Ooij PJAM. How fit are military hyperbaric personnel after an asymptomatic or mild symptomatic COVID-19 infection? A retrospective study. Diving Hyperb Med 2023; 53:120-128. [PMID: 37365129 PMCID: PMC10584392 DOI: 10.28920/dhm53.2.120-128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 04/08/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION In the diving community there is a special need to know if asymptomatic or mild COVID-19 disease impacts the cardiopulmonary functioning of individuals with occupational exposure to extreme environments. To date, no controlled studies have been conducted comparing COVID-19-infected hyperbaric employees and non-COVID-19-infected peers in a military setting. METHODS Between June 2020 and June 2021, healthy, hyperbaric, military personnel aged between 18 and 54 years old, who had recovered from asymptomatic or subclinical COVID-19 disease at least one month earlier, were analysed. Non-COVID-infected peers with medical assessments during the same period were used as the control group. Somatometry, spirometry, VO₂ max, and DLCO were measured for each group. RESULTS No clinically relevant differences in somatometry, lung function tests, and exercise testing were found between the COVID-19 group and the controls. However, the percentage of individuals with a decrease in estimated VO2-max of 10% or more was significantly greater in the COVID group than in the control group (24 vs. 7.8%, P = 0.004). CONCLUSIONS After asymptomatic or mild symptomatic COVID-19 infections, military hyperbaric employees are as fit as those who had not encountered COVID-19. As this research was based on a military population, it cannot be extrapolated to a nonmilitary population. Further studies in nonmilitary populations are necessary to determine the medical relevance of the present findings.
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Affiliation(s)
- Jan-Peter Schaap
- Royal Netherlands Navy Diving and Submarine Medical Center, 1780 CA Den Helder, The Netherlands
| | | | - Antoinette Houtkooper
- Royal Netherlands Navy Diving and Submarine Medical Center, 1780 CA Den Helder, The Netherlands
| | - Edwin L Endert
- Royal Netherlands Navy Diving and Submarine Medical Center, 1780 CA Den Helder, The Netherlands
| | - Pieter-Jan A M van Ooij
- Royal Netherlands Navy Diving and Submarine Medical Center, 1780 CA Den Helder, The Netherlands
- Department of Pulmonary Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Corresponding author: Dr Pieter-Jan AM van Ooij, Royal Netherlands Navy Diving and Submarine Medical Center, 1780 CA Den Helder, The Netherlands,
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2
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Moellhoff N, Groene P, Ney L, Hauer D. [Development of a giant bulla under spontaneous breathing by self-inflicted lung injury in a patient with COVID-19 pneumonia]. Anaesthesist 2022; 71:303-306. [PMID: 34811572 PMCID: PMC8608363 DOI: 10.1007/s00101-021-01072-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 10/20/2021] [Accepted: 10/23/2021] [Indexed: 11/24/2022]
Abstract
The outbreak of SARS-CoV‑2 and the associated COVID-19 pandemic pose major challenges to healthcare systems worldwide. New data on diagnosis, clinical presentation and treatment of the disease are published on a daily basis. This case report describes the fatal course of severe COVID-19 pneumonia in an 81-year-old patient with no previous pulmonary disease who developed a giant bulla during non-invasive high-flow oxygen therapy. Virus-induced diffuse destruction of alveolar tissue or patient self-inflicted lung injury (P-SILI) are discussed as possible pathomechanisms. Future studies must determine whether lung-protective mechanical ventilation with high levels of sedation and paralysis to suppress spontaneous respiratory drive and to reduce transpulmonary pressure can prevent structural lung damage induced both by the virus and P‑SILI in COVID-19 patients with ARDS.
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Affiliation(s)
- Nicholas Moellhoff
- Abteilung für Hand‑, Plastische und Ästhetische Chirurgie, Klinikum der Universität München, LMU München, München, Deutschland
| | - Philipp Groene
- Intensivstation ANIS 5, Klinik für Anaesthesiologie, Klinikum der Universität München, LMU München, Nussbaumstraße 20, 80336, München, Deutschland
| | - Ludwig Ney
- Intensivstation ANIS 5, Klinik für Anaesthesiologie, Klinikum der Universität München, LMU München, Nussbaumstraße 20, 80336, München, Deutschland
| | - Daniela Hauer
- Intensivstation ANIS 5, Klinik für Anaesthesiologie, Klinikum der Universität München, LMU München, Nussbaumstraße 20, 80336, München, Deutschland.
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3
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Pantazopoulos IN, Pagonis A, Perlepe G, Kampolis CF, Gourgoulianis KI. Hydropneumothorax With Persistent Air Leak in a Patient With Mild COVID-19 Disease. Cureus 2022; 14:e22150. [PMID: 35308755 PMCID: PMC8919764 DOI: 10.7759/cureus.22150] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2022] [Indexed: 01/10/2023] Open
Abstract
COVID-19 is a pandemic viral disease with a catastrophic global impact. The severity of COVID-19 symptoms ranges from very mild to severe and affects mainly the respiratory system. Spontaneous pneumothorax and pleural effusion are rarely seen in spontaneously breathing COVID-19 patients. We herein report a case of a patient with mild COVID-19 disease presenting to the emergency department with hydropneumothorax. Due to persistent air leak, the patient was managed with video-assisted thoracoscopic surgery (VATS) bullectomy and talc pleurodesis. Clinicians managing these patients should be alert to early diagnose this complication.
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4
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Shrestha DB, Sedhai YR, Budhathoki P, Adhikari A, Pokharel N, Dhakal R, Kafle S, Yadullahi Mir WA, Acharya R, Kashiouris MG, Parker MS. Pulmonary barotrauma in COVID-19: A systematic review and meta-analysis. Ann Med Surg (Lond) 2022; 73:103221. [PMID: 35003730 PMCID: PMC8721930 DOI: 10.1016/j.amsu.2021.103221] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/23/2021] [Accepted: 12/23/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND An ever-increasing number of studies have reported an increased incidence of spontaneous pulmonary barotrauma such as pneumothorax, pneumomediastinum, and subcutaneous emphysema in patients with COVID-19. We conducted this systematic review and meta-analysis to assess the value and significance of the available data. METHODS A thorough systematic search was conducted to identify studies of barotrauma in hospitalized patients with COVID-19. Data analysis of case reports was done using a statistical package for the social sciences (SPSS) version 22, and meta-analysis was performed using CMA-3. RESULTS We identified a total of 4488 studies after thorough database searching.118 case reports and series, and 15 observational studies were included in the qualitative analysis. Fifteen studies were included in the quantitative analysis. The observational studies reported barotrauma in 4.2% (2.4-7.3%) among hospitalized patients; 15.6% (11-21.8%) among critically ill patients; and 18.4% (13-25.3%) in patients receiving invasive mechanical ventilation, showing a linear relationship of barotrauma with the severity of the disease. In addition, barotrauma was associated with a longer length of hospital stay, more extended ICU stay, and higher in-hospital mortality. Also, a slightly higher odds of barotrauma was seen in COVID-19 ARDS compared with non-COVID-19 ARDS. CONCLUSION COVID-19 pneumonia is associated with a higher incidence of barotrauma. It presents unique challenges for invasive and non-invasive ventilation management. Further studies are required to unravel the underlying pathophysiology and develop safer management strategies.
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Affiliation(s)
| | - Yub Raj Sedhai
- Department of Internal Medicine, Division of Hospital Medicine, Virginia Commonwealth University, School of Medicine, Richmond, VA, USA
| | - Pravash Budhathoki
- Department of Internal Medicine, BronxCare Health System, Bronx, NY, USA
| | - Ayush Adhikari
- Department of Anesthesia and Critical Care, TU Teaching Hospital, Kathmandu, Nepal
| | - Nisheem Pokharel
- Department of Internal Medicine, KIST Medical College, Lalitpur, Nepal
| | - Richa Dhakal
- Department of Internal Medicine, Kathmandu Medical College, Kathmandu, Nepal
| | - Satyasuna Kafle
- Department of Intensive Care Unit, Bhaktapur Hospital, Bhaktapur, Nepal
| | | | - Roshan Acharya
- Department of Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, NC, USA
| | - Markos G. Kashiouris
- Department of Internal Medicine, Pulmonary and Critical Care, Virginia Commonwealth University, School of Medicine, Richmond, VA, USA
| | - Mark S. Parker
- Department of Radiology, Division of Thoracic Imaging, Virginia Commonwealth University, School of Medicine, Richmond, VA, USA
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5
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Reandelar MJ, Park E, D'Costa C, Salahudin A, Mamoon Y. Unusual Presentation of a Rare Pneumothorax in a Patient With COVID-19 Pneumonia: A Case Report. Cureus 2021; 13:e19273. [PMID: 34881127 PMCID: PMC8644113 DOI: 10.7759/cureus.19273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2021] [Indexed: 12/05/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a respiratory and systemic disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Since the start of the COVID-19 pandemic, pneumothorax (PTX) has only been reported as a complication of the virus-induced pneumonia in less than 1% of cases. The majority of them developed symptoms in the setting of either an underlying history of lung disease or being placed on a mechanical ventilator during admission. The authors report a unique case of PTX in a patient with a recent COVID pneumonia that did not fit the aforementioned clinical picture - a 41-year-old male with a complete collapse of his right lung who was previously admitted for COVID pneumonia with no known pulmonary history and was not intubated. A chest tube was placed with the resolution of the PTX and the patient is being monitored on the medicine floor.
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Affiliation(s)
- Mac Josh Reandelar
- Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Jamaica, USA
| | - Elizabeth Park
- Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Jamaica, USA
| | - Celestina D'Costa
- Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Jamaica, USA
| | - Armish Salahudin
- Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Jamaica, USA
| | - Yusufal Mamoon
- Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Jamaica, USA
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6
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Adhikary AB, R U, Patel NB, S VP, Boruah P, Chandrakar S. Spectrum of pneumothorax/pneumomediastinum in patients with coronavirus disease 2019. Qatar Med J 2021; 2021:41. [PMID: 34604018 PMCID: PMC8473938 DOI: 10.5339/qmj.2021.41] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 04/04/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Spontaneous pneumothorax/pneumomediastinum is an uncommon complication of coronavirus disease 2019 (COVID-19). Herein, we describe the clinical spectrum and outcomes of COVID-19-associated pneumothorax/pneumomediastinum in critical care settings. MATERIALS AND METHODS We hereby present a case series of 12 patients who tested positive for COVID-19 and developed air leak injuries in critical care settings in a tertiary care center in Northern India. Infection with severe acute respiratory syndrome coronavirus-2 was confirmed by nasal/oropharyngeal swab testing using real-time reverse-transcription polymerase chain reaction test. The clinical spectrum and outcomes of these patients were assessed. Each case has been presented as a brief synopsis. RESULTS The onset of pneumothorax/pneumomediastinum varied from 11 to 28 days after the occurrence of initial symptoms and caused worsening of respiratory parameters in most patients. Of the 12 patients, eight were males who developed air leak injuries. One patient was a current smoker, and three patients had underlying lung disorders. Two patients with spontaneous breathing were managed conservatively. All intubated patients who developed air leak injuries died (100% mortality rate). CONCLUSION Pneumothorax/pneumomediastinum is a rare and life-threatening complication in mechanically ventilated patients with COVID-19. Further research is needed to understand the pathophysiology behind the development of air leak injuries in patients with COVID-19.
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Affiliation(s)
- Anirban B Adhikary
- Department of Anaesthesiology and Intensive Care Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Udhyachander R
- Department of Anaesthesiology and Intensive Care Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Nupur B Patel
- Department of Anaesthesiology and Intensive Care Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Vadhan Prasanna S
- Department of Anaesthesiology and Intensive Care Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Priyanka Boruah
- Department of Anaesthesiology and Intensive Care Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Saurabh Chandrakar
- Department of Anaesthesiology and Intensive Care Medicine, All India Institute of Medical Sciences, Rishikesh, India
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7
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Iuorio A, Nagar F, Attianese L, Grasso A, Torretta G, Fusco P, Ferrara M, Ferraro F. Spontaneous Pneumomediastinum and Pneumothorax in Nonintubated COVID-19 Patients: A Multicenter Case Series. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e933405. [PMID: 34480011 PMCID: PMC8428620 DOI: 10.12659/ajcr.933405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Case series
Patients: Male, 78-year-old • Male, 70-year-old • Male, 73-year-old
Final Diagnosis: Pneumomediastinum • pneumothorax
Symptoms: Cough
Medication: —
Clinical Procedure: —
Specialty: Anesthesiology
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Affiliation(s)
- Angela Iuorio
- Department of Anesthesia and Intensive Care, Frangipane Hospital, Ariano Irpino, Italy
| | - Francesca Nagar
- Department of Women, Children, General and Specialist Surgery, University of Campania "L. Vanvitelli", Naples, Italy
| | - Laura Attianese
- Department of Women, Children, General and Specialist Surgery, University of Campania "L. Vanvitelli", Naples, Italy
| | - Anna Grasso
- Department of Women, Children, General and Specialist Surgery, University of Campania "L. Vanvitelli", Naples, Italy
| | - Giacomo Torretta
- Department of Anesthesia and Intensive Care, Frangipane Hospital, Ariano Irpino, Italy
| | - Pierluigi Fusco
- Department of Anesthesia and Intensive Care, Frangipane Hospital, Ariano Irpino, Italy
| | - Maurizio Ferrara
- Department of Anesthesia and Intensive Care, Frangipane Hospital, Ariano Irpino, Italy
| | - Fausto Ferraro
- Department of Women, Children, General and Specialist Surgery, University of Campania "L. Vanvitelli", Naples, Italy
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8
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Agrafiotis AC, Rummens P, Lardinois I. Pneumothorax in otherwise healthy non-intubated patients suffering from COVID-19 pneumonia: a systematic review. J Thorac Dis 2021; 13:4519-4529. [PMID: 34422378 PMCID: PMC8339789 DOI: 10.21037/jtd-21-208] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 04/23/2021] [Indexed: 01/08/2023]
Abstract
Background Cases of spontaneous pneumothorax have been described in patients suffering from coronavirus disease 2019 (COVID-19) pneumonia. The aim of this study is to systematically review all the cases of spontaneous pneumothorax that occurred in healthy patients with no underlying lung disease and who did not receive invasive mechanical ventilation. Methods A PubMed research was conducted. The following data were collected: age, sex, side of the pneumothorax, smoking habit, time form onset of symptoms to the diagnosis of pneumothorax, the development of new bullous lesions on computed tomography and the type of treatment. In order to analyze the most homogeneous population possible, intubated patients were deliberately excluded. In total, 44 cases of spontaneous pneumothorax in otherwise healthy patients were taken into account. Since the available data were extracted from small observational studies, no particular bias risk assessment was performed. Descriptive statistics were used to synthesize results. Results There were 37 male (84.1%) and 6 female (13.6%) patients. The majority of patients (66%) were treated only by chest tube thoracostomy, which most of the times resulted in a complete resolution of the pneumothorax. Simple surveillance was applied in 10 cases. Three patients underwent minimally invasive surgery. In 14 cases (31.8%) air-filled lesions were detected on imaging. Eleven patients received corticosteroids during their hospital stay. In the majority of cases (86.3%) the pneumothorax was resolved. Discussion Even if the level of evidence, derived from case reports and small case series is low, the existence of a true secondary spontaneous pneumothorax due to SARS-CoV-2 should be recognized. Imaging techniques should be repeated throughout the clinical course of the patients in order to detect newly developed pulmonary complications. Surgical treatment is feasible and patients whose general condition permits, should be offered surgery according to the existing guidelines regarding spontaneous pneumothorax. National registries and databases are necessary in order to better understand the pathogenesis and complications of this novel entity.
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Affiliation(s)
- Apostolos C Agrafiotis
- Department of Thoracic Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Peter Rummens
- Department of Respiratory Medicine, Saint-Pierre University Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Ines Lardinois
- Department of Thoracic Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
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9
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Cabrera Gaytán DA, Pérez Andrade Y, Espíritu Valenzo Y. Pneumothorax due to COVID-19: Analysis of case reports. Respir Med Case Rep 2021; 34:101490. [PMID: 34336592 PMCID: PMC8312092 DOI: 10.1016/j.rmcr.2021.101490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/14/2021] [Accepted: 07/23/2021] [Indexed: 02/07/2023] Open
Abstract
Cases of pneumothorax/pneumomediastinum have been reported in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); however, the time to onset and hospital stay have rarely been studied. Coronavirus disease 2019 (COVID-19) patients with these complications are described to determine the time to onset, associated comorbidities, and location and duration of pneumothorax. A search in PubMed yielded simple frequencies and a bivariate analysis of deaths. There were 113 confirmed cases in 67 articles. The median time from the date of hospital admission to the presence of pneumothorax was 8 days. Right hemithorax was the most frequent form of pneumothorax. Almost half of the patients required intubation for invasive mechanical ventilation. Although the frequency of this phenomenon was not high among hospitalized patients with confirmed SARS-CoV-2, it was high among those who developed acute respiratory distress syndrome (ARDS). This study contributes to the literature because it presents a large number of patients who developed pneumothorax after admission, which was characterized by clinical deterioration (dyspnea, tachypnea, pleuritic chest pain, and subcutaneous emphysema) and low oxygen saturation levels. Pneumothorax/pneumomediastinum is recommended as a differential diagnosis, even without considering the presence of chronic pulmonary comorbidities or invasive mechanical ventilation.
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Affiliation(s)
- David Alejandro Cabrera Gaytán
- Coordinación de Investigación en Salud, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc # 330 Block “B” 4° Floor, Annex to the Unidad de Congresos del Centro Médico Nacional Siglo XXI, Neighborhood Doctores, Alcaldía Cuauhtmoc, CP. 06720, Mexico City, Mexico
| | - Yadira Pérez Andrade
- Coordinación de Vigilancia Epidemiológica, Instituto Mexicano del Seguro Social, Mier y Pesado No. 120, Neighborhood Del Valle Benito Juárez, CP. 03100, Mexico City, Mexico
| | - Yuridia Espíritu Valenzo
- Hospital General Regional No. 72, Instituto Mexicano del Seguro Social, Av. Gustavo Baz Prada S/N, Neighborhood Centro Industrial Tlalnepantla, CP 54000, Tlalnepantla de Baz, Estado de México, Mexico
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10
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Sahagun J, Chopra A, David AG, Dao D, Chittivelu S. Secondary Spontaneous Pneumothorax in a COVID-19 Recovered Patient. Cureus 2021; 13:e16415. [PMID: 34401214 PMCID: PMC8364669 DOI: 10.7759/cureus.16415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2021] [Indexed: 12/30/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is an infectious disease primarily affecting the lungs with a spectrum of post-viral complications. There are well-described examples of pneumonia, empyema, pneumomediastinum, and spontaneous pneumothorax cases following COVID-19 infection within the literature. However, there is insufficient evidence implicating the cause of spontaneous pneumothorax in COVID-19 recovered patients. We present a previously infected COVID-19 patient who developed a secondary spontaneous pneumothorax two weeks after recovering. A review of the literature for similar cases was limited and therefore includes a summary of recommendations. Overall, the literature establishes that pneumothorax can occur during different phases of COVID-19 in patients without a history of pulmonary disease or barotrauma and is not necessarily associated with the severity of the viral infection. As in the case of our patient, the culmination of chronic inflammatory changes and an acute exacerbation from COVID-19 further predisposed him to a secondary spontaneous pneumothorax. In summary, all cases of recovered COVID-19 patients should maintain close follow-up with their physician and seek medical attention if acute respiratory symptoms develop.
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Affiliation(s)
- Joseph Sahagun
- Pulmonary Medicine, University of Illinois College of Medicine-Peoria, Peoria, USA
| | - Amit Chopra
- Pulmonary Medicine, University of Illinois College of Medicine-Peoria, Peoria , USA
| | - Alan G David
- Pulmonary Medicine, University of Illinois College of Medicine-Peoria, Peoria, USA
| | - David Dao
- Pulmonary Medicine, University of Illinois College of Medicine-Peoria, Peoria, USA
| | - Subramanyam Chittivelu
- Pulmonary and Critical Care Medicine, University of Illinois College of Medicine at Peoria - Order of Saint Francis Medical Center, Peoria, USA
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11
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Saha BK, Chong WH, Austin A, Kathuria R, Datar P, Shkolnik B, Beegle S, Chopra A. Pleural abnormalities in COVID-19: a narrative review. J Thorac Dis 2021; 13:4484-4499. [PMID: 34422375 PMCID: PMC8339774 DOI: 10.21037/jtd-21-542] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/25/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This narrative review aims to provide a detailed overview of pleural abnormalities in patients with coronavirus disease 19 or COVID-19. BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) is a novel beta coronavirus responsible for COVID-19. Although pulmonary parenchymal and vascular changes associated with COVID-19 are well established, pleural space abnormalities have not been the primary focus of investigations. METHODS Narrative overview of the medical literature regarding pleural space abnormalities in COVID-19. The appropriate manuscripts were identified by searching electronic medical databases and by hand searching the bibliography of the identified papers. Pleural abnormalities on transverse and ultrasound imaging are discussed. The incidence, clinical features, pathophysiology, and fluid characteristics of pleural effusion are reviewed. Studies reporting pneumothorax and pneumomediastinum are examined to evaluate for pathogenesis and prognosis. A brief comparative analysis of pleural abnormalities among patients with COVID-19, severe acute respiratory syndrome (SARS), and Middle Eastern respiratory syndrome (MERS) has been provided. CONCLUSIONS Radiologic pleural abnormalities are common in COVID-19, but the incidence of pleural effusion appears to be low. Pneumothorax is rare and does not independently predispose the patient to worse outcomes. SARS-CoV-2 infects the pleural space; however, whether the pleural fluid can propagate the infection is unclear.
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Affiliation(s)
- Biplab K. Saha
- Department of Pulmonary and Critical Care Medicine, Ozarks Medical Center, West Plains, MO, USA
| | - Woon H. Chong
- Department of Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY, USA
| | - Adam Austin
- Department of Pulmonary and Critical Care Medicine, University of Florida, Gainesville, FL, USA
| | - Ritu Kathuria
- Department of Infectious Disease, Ozarks Medical Center, West Plains, MO, USA
| | - Praveen Datar
- Department of Pulmonary and Critical Care Medicine, Ozarks Medical Center, West Plains, MO, USA
| | - Boris Shkolnik
- Department of Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY, USA
| | - Scott Beegle
- Department of Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY, USA
| | - Amit Chopra
- Department of Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY, USA
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12
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Bosher O, Syed MA, Bikmalla S. Favourable outcome after a delayed complication secondary to COVID-19. BMJ Case Rep 2021; 14:14/4/e241049. [PMID: 33846187 PMCID: PMC8048003 DOI: 10.1136/bcr-2020-241049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
A 41-year-old man was admitted to hospital with 7-day history of fever, cough and having had a positive SARS-CoV-2 PCR test. The chest radiograph (CXR) showed bilateral peripheral parenchymal infiltrates. He required 4 L/min oxygen via nasal cannula for 72 hours and was discharged after 7 days with appropriate advice. Four weeks from initial hospital admission, he presented with worsening cough, left chest pain and breathlessness. CXR showed left pneumothorax, and CT pulmonary angiogram (CTPA) scan confirmed left pneumothorax with mediastinal shift and a subpleural bulla. Intercostal chest drain was inserted with good resolution of symptoms and lung re-expansion. Follow-up CT scan 2 months later showed complete resolution of the parenchymal abnormalities. Our case demonstrates the development of pneumothorax as a delayed complication in a patient with COVID-19 who did not require ventilatory support. The case also illustrates a favourable outcome, that is, complete resolution of parenchymal destruction due to COVID-19.
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Affiliation(s)
- Olivia Bosher
- Respiratory Medicine, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Muneer Ahmed Syed
- Respiratory Medicine, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Shiva Bikmalla
- Respiratory Medicine, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
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13
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Cut TG, Tudoran C, Lazureanu VE, Marinescu AR, Dumache R, Tudoran M. Spontaneous Pneumomediastinum, Pneumothorax, Pneumopericardium and Subcutaneous Emphysema-Not So Uncommon Complications in Patients with COVID-19 Pulmonary Infection-A Series of Cases. J Clin Med 2021; 10:1346. [PMID: 33805118 PMCID: PMC8036962 DOI: 10.3390/jcm10071346] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/18/2021] [Accepted: 03/23/2021] [Indexed: 12/16/2022] Open
Abstract
(1) Background: Spontaneous pneumomediastinum (PM), pneumothorax (PT), and pneumopericardium (PP) were recently reported as rare complications in patients with severe COVID-19 pneumonia, and our study aims to follow the evolution of these involvements in 11 cases. The presumed pathophysiological mechanism is air leak due to extensive diffuse alveolar damage followed by alveolar rupture. (2) Methods: We followed the occurrence of PM, PN, PP, and subcutaneous emphysema (SE) in 1648 patients hospitalized during the second outbreak of COVID-19 (October 2020-January 2021) in the main hospital of infectious diseases of our county and recorded their demographic data, laboratory investigations and clinical evolution. (3) Results: Eleven patients (0.66%) developed PM, with eight of them having associated PT, one PP, and seven SE, in the absence of mechanical ventilation. Eight patients (72.72%) died and only three (27.27%) survived. All subjects were nonsmokers, without known pulmonary pathology or risk factors for such complications. (4) Conclusions: pneumomediastinum, pneumothorax, and pneumopericardium are not so uncommon complications of SARS-CoV2 pneumonia, being observed mostly in male patients with severe forms and associated with prolonged hospitalization and poor prognosis. In some cases, with mild forms and reduced pulmonary injury, the outcome is favorable, not requiring surgical procedures, mechanical ventilation, or intensive care stay.
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Affiliation(s)
- Talida Georgiana Cut
- Department XIII, Discipline of Infectious Diseases, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania; (T.G.C.); (V.E.L.); (A.R.M.)
| | - Cristina Tudoran
- Department VII, Internal Medicine II, Discipline of Cardiology, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania;
- County Emergency Hospital “ Pius Brinzeu”, L. Rebreanu Str., Nr. 156, 300041 Timisoara, Romania
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
| | - Voichita Elena Lazureanu
- Department XIII, Discipline of Infectious Diseases, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania; (T.G.C.); (V.E.L.); (A.R.M.)
| | - Adelina Raluca Marinescu
- Department XIII, Discipline of Infectious Diseases, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania; (T.G.C.); (V.E.L.); (A.R.M.)
| | - Raluca Dumache
- Department VIII, Discipline of Forensic Medicine, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania;
| | - Mariana Tudoran
- Department VII, Internal Medicine II, Discipline of Cardiology, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania;
- County Emergency Hospital “ Pius Brinzeu”, L. Rebreanu Str., Nr. 156, 300041 Timisoara, Romania
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
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Abstract
Coronavirus disease 2019 (COVID-19) is a novel infectious disease affecting the general population worldwide. A fever and cough are the common clinical presentations of COVID-19. In most of these patients, computed tomography (CT) shows bilateral peripheral ground-glass opacities. We herein report a case of hemoptysis and lung bulla in the convalescent phase of COVID-19. Based on the clinical observations, alveolar destruction was likely associated with hemoptysis and bulla formation. Therefore, we suggest the follow-up of COVID-19 patients whose clinical parameters indicate alveolar damage, even after their symptoms improve.
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Affiliation(s)
- Lubna Sato
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Noriko Kinoshita
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Takato Nakamoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
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15
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Pneumothorax in Mechanically Ventilated Patients with COVID-19 Infection. Case Rep Crit Care 2021; 2021:6657533. [PMID: 33505730 PMCID: PMC7798182 DOI: 10.1155/2021/6657533] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/06/2020] [Accepted: 01/05/2021] [Indexed: 02/07/2023] Open
Abstract
Data on patient-related factors associated with pneumothorax among critically ill patients with COVID-19 pneumonia is limited. Reports of spontaneous pneumothorax in patients with coronavirus disease 2019 (COVID-19) suggest that the COVID-19 infection could itself cause pneumothorax in addition to the ventilator-induced trauma among mechanically ventilated patients. Here, we report a case series of five mechanically ventilated patients with COVID-19 infection who developed pneumothorax. Consecutive cases of intubated patients in the intensive care unit with the diagnosis of COVID-19 pneumonia and pneumothorax were included. Data on their demographics, preexisting risk factors, laboratory workup, imaging findings, treatment, and survival were collected retrospectively between March and July 2020. Four out of five patients (4/5; 80%) had a bilateral pneumothorax, while one had a unilateral pneumothorax. Of the four patients with bilateral pneumothorax, three (3/4; 75%) had secondary bacterial pneumonia, two had pneumomediastinum and massive subcutaneous emphysema, and one of these two had an additional pneumoperitoneum. A surgical chest tube or pigtail catheter was placed for the management of pneumothorax. Three out of five patients with pneumothorax died (3/5; 60%), and all of them had bilateral involvement. The data from these cases suggest that pneumothorax is a potentially fatal complication of COVID-19 infection. Large prospective studies are needed to study the incidence of pneumothorax and its sequelae in patients with COVID-19 infection.
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16
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Miró Ò, Llorens P, Jiménez S, Piñera P, Burillo-Putze G, Martín A, Martín-Sánchez FJ, García-Lamberetchs EJ, Jacob J, Alquézar-Arbé A, Mòdol JM, López-Díez MP, Guardiola JM, Cardozo C, Lucas Imbernón FJ, Aguirre Tejedo A, García García Á, Ruiz Grinspan M, Llopis Roca F, González Del Castillo J. 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 2020; 159:1241-1255. [PMID: 33227276 PMCID: PMC7678420 DOI: 10.1016/j.chest.2020.11.013] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/04/2020] [Accepted: 11/11/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Recent reports of patients with coronavirus disease 2019 (COVID-19) developing pneumothorax correspond mainly to case reports describing mechanically ventilated patients. The real incidence, clinical characteristics, and outcome of spontaneous pneumothorax (SP) as a form of COVID-19 presentation remain to be defined. RESEARCH QUESTION Do the incidence, risk factors, clinical characteristics, and outcomes of SP in patients with COVID-19 attending EDs differ compared with COVID-19 patients without SP and non-COVID-19 patients with SP? STUDY DESIGN AND METHODS This case-control study retrospectively reviewed all patients with COVID-19 diagnosed with SP (case group) in 61 Spanish EDs (20% of Spanish EDs) and compared them with two control groups: COVID-19 patients without SP and non-COVID-19 patients with SP. The relative frequencies of SP were estimated in COVID-19 and non-COVID-19 patients in the ED, and annual standardized incidences were estimated for both populations. Comparisons between case subjects and control subjects included 52 clinical, analytical, and radiologic characteristics and four outcomes. RESULTS We identified 40 occurrences of SP in 71,904 patients with COVID-19 attending EDs (0.56‰; 95% CI, 0.40‰-0.76‰). This relative frequency was higher than that among non-COVID-19 patients (387 of 1,358,134, 0.28‰; 95% CI, 0.26‰-0.32‰; OR, 1.93; 95% CI, 1.41-2.71). The standardized incidence of SP was also higher in patients with COVID-19 (34.2 vs 8.2/100,000/year; OR, 4.19; 95% CI, 3.64-4.81). Compared with COVID-19 patients without SP, COVID-19 patients developing SP more frequently had dyspnea and chest pain, low pulse oximetry readings, tachypnea, and increased leukocyte count. Compared with non-COVID-19 patients with SP, case subjects differed in 19 clinical variables, the most prominent being a higher frequency of dysgeusia/anosmia, headache, diarrhea, fever, and lymphopenia (all with OR > 10). All the outcomes measured, including in-hospital death, were worse in case subjects than in both control groups. INTERPRETATION SP as a form of COVID-19 presentation at the ED is unusual (< 1‰ cases) but is more frequent than in the non-COVID-19 population and could be associated with worse outcomes than SP in non-COVID-19 patients and COVID-19 patients without SP.
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Affiliation(s)
- Òscar Miró
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - Pere Llorens
- Emergency Department, Hospital General de Alicante, University Miguel Hernández, Elche, Spain
| | - Sònia Jiménez
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Pascual Piñera
- Emergency Department, Hospital Reina Sofía, Murcia, Spain
| | - Guillermo Burillo-Putze
- Emergency Department, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Tenerife, Spain
| | - Alfonso Martín
- Emergency Department, Hospital Severo Ochoa, Leganés, Madrid, Spain
| | | | | | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Aitor Alquézar-Arbé
- Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Josep Maria Mòdol
- Emergency Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | | | - Carlos Cardozo
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain; Emergency Department, Hospital Austral, Buenos Aires, Argentina
| | | | | | | | | | - Ferran Llopis Roca
- Emergency Department, Hospital Universitari de Bellvitge, Barcelona, Spain
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Dennison J, Carlson S, Faehling S, Lieb M, Mubarik A. Case report: Spontaneous pneumothorax in resolved, uncomplicated COVID-19 Pneumonia-A literature review. Respir Med Case Rep 2020; 31:101291. [PMID: 33200068 PMCID: PMC7658556 DOI: 10.1016/j.rmcr.2020.101291] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/04/2020] [Accepted: 11/09/2020] [Indexed: 02/07/2023] Open
Abstract
As the global COVID-19 pandemic has progressed, awareness of uncommon presentations and complications has increased. The actual incidence of spontaneous pneumothorax was found to be 0.66%, or six patients out of 902 who tested positive in recently published literature of 3368 patients (Zantah M, Dominguez Castillo E, Townsend R, Dikengil F, Criner GJ. Pneumothorax in COVID-19 disease-incidence and clinical characteristics. Respir Res. 2020 Sep 16; 21 (1):236.). Of those six patients, only two (0.22%) were not associated with mechanical ventilation barotrauma or comorbid lung disease such as COPD. Here, we present a spontaneous pneumothorax and pneumomediastinum in a patient four days after he had been discharged from hospitalization due to uncomplicated COVID-19 pneumonia.
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Affiliation(s)
| | | | | | - Margaret Lieb
- Medical College of Wisconsin, Wausau, WI, 54401, USA
| | - Ateeq Mubarik
- Ascension Saint Michael's Hospital, Stevens Point, WI, 54481, USA.,Medical College of Wisconsin, USA
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