Recurrent Pneumothorax in a Critically Ill Ventilated COVID-19 Patient
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. A 33-year-old woman presented to the hospital with a one-week history of cough, shortness...
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| Format: | Article |
| Language: | English |
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Wiley
2020-01-01
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| Series: | Case Reports in Critical Care |
| Online Access: | http://dx.doi.org/10.1155/2020/8896923 |
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| author | Lucas Rehnberg Robert Chambers Selina Lam Martin Chamberlain Ahilanandan Dushianthan |
| author_facet | Lucas Rehnberg Robert Chambers Selina Lam Martin Chamberlain Ahilanandan Dushianthan |
| author_sort | Lucas Rehnberg |
| collection | DOAJ |
| description | 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. 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. She tested positive for COVID-19 and subsequently, her respiratory function rapidly deteriorated, necessitating endotracheal intubation and mechanical ventilation. She had severe hypoxic respiratory failure requiring a protracted period on the mechanical ventilator with different ventilation strategies and multiple cycles of prone positioning. During her proning, after two weeks on the intensive care unit, she developed tension pneumothorax that required bilateral intercostal chest drains (ICD) to stabilise her. After 24 days, she had a percutaneous tracheostomy and began her respiratory wean; however, this was limited due to the ongoing infection. Thorax CT demonstrated a left-sided pneumothorax, with bilateral pneumatoceles and a sizeable, complex hydropneumothorax. Despite the insertion of ICDs, the hydropneumothorax persisted over months and initially progressed in size on serial scans needing multiple ICDs. She was too ill for surgical interventions initially, opting for conservative management. After 60 days, she successfully underwent a video-assisted thoracoscopic surgery (VATS) for a washout and placement of further ICDs. She was successfully decannulated after 109 days on the intensive care unit and was discharged to a rehabilitation unit after 116 days of being an inpatient, with her last thorax CT showing some residual pneumatoceles but significant improvement. Late changes may mean patients recovering from the COVID-19 infection are at increased risk of pneumothoracies. Clinicians need to be alert to this, especially as bullous rupture may not present as a classical pneumothorax. |
| format | Article |
| id | doaj-art-60fc473d73e54b179da37fc0df391fe6 |
| institution | Kabale University |
| issn | 2090-6420 2090-6439 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Critical Care |
| spelling | doaj-art-60fc473d73e54b179da37fc0df391fe62025-02-03T06:46:55ZengWileyCase Reports in Critical Care2090-64202090-64392020-01-01202010.1155/2020/88969238896923Recurrent Pneumothorax in a Critically Ill Ventilated COVID-19 PatientLucas Rehnberg0Robert Chambers1Selina Lam2Martin Chamberlain3Ahilanandan Dushianthan4General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, Tremona Road, Southampton SO16 6YD, UKGeneral Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, Tremona Road, Southampton SO16 6YD, UKCardiothoracic Radiology, University Hospital Southampton NHS Foundation Trust, Southampton, Tremona Road, Southampton SO16 6YD, UKDepartment of Thoracic Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, Tremona Road, Southampton SO16 6YD, UKGeneral Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, Tremona Road, Southampton SO16 6YD, UKWe 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. 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. She tested positive for COVID-19 and subsequently, her respiratory function rapidly deteriorated, necessitating endotracheal intubation and mechanical ventilation. She had severe hypoxic respiratory failure requiring a protracted period on the mechanical ventilator with different ventilation strategies and multiple cycles of prone positioning. During her proning, after two weeks on the intensive care unit, she developed tension pneumothorax that required bilateral intercostal chest drains (ICD) to stabilise her. After 24 days, she had a percutaneous tracheostomy and began her respiratory wean; however, this was limited due to the ongoing infection. Thorax CT demonstrated a left-sided pneumothorax, with bilateral pneumatoceles and a sizeable, complex hydropneumothorax. Despite the insertion of ICDs, the hydropneumothorax persisted over months and initially progressed in size on serial scans needing multiple ICDs. She was too ill for surgical interventions initially, opting for conservative management. After 60 days, she successfully underwent a video-assisted thoracoscopic surgery (VATS) for a washout and placement of further ICDs. She was successfully decannulated after 109 days on the intensive care unit and was discharged to a rehabilitation unit after 116 days of being an inpatient, with her last thorax CT showing some residual pneumatoceles but significant improvement. Late changes may mean patients recovering from the COVID-19 infection are at increased risk of pneumothoracies. Clinicians need to be alert to this, especially as bullous rupture may not present as a classical pneumothorax.http://dx.doi.org/10.1155/2020/8896923 |
| spellingShingle | Lucas Rehnberg Robert Chambers Selina Lam Martin Chamberlain Ahilanandan Dushianthan Recurrent Pneumothorax in a Critically Ill Ventilated COVID-19 Patient Case Reports in Critical Care |
| title | Recurrent Pneumothorax in a Critically Ill Ventilated COVID-19 Patient |
| title_full | Recurrent Pneumothorax in a Critically Ill Ventilated COVID-19 Patient |
| title_fullStr | Recurrent Pneumothorax in a Critically Ill Ventilated COVID-19 Patient |
| title_full_unstemmed | Recurrent Pneumothorax in a Critically Ill Ventilated COVID-19 Patient |
| title_short | Recurrent Pneumothorax in a Critically Ill Ventilated COVID-19 Patient |
| title_sort | recurrent pneumothorax in a critically ill ventilated covid 19 patient |
| url | http://dx.doi.org/10.1155/2020/8896923 |
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