Post COVID-19 large pneumatocele: clinical and pathological perspectives

Abstract

A middle aged COVID-19 male patient presented 2 weeks after discharge with new onset of dyspnoea and desaturation. Radiological studies revealed right side pneumothorax and lower lobe cystic air space. Chest drain was inserted and on a later date the patient underwent thoracoscopic surgery where a large pneumatocele was identified. Deroofing and closure of sources of air leak were done. Histopathological examination demonstrated extensive fibrosis, intra-alveolar Haemorrhage and pneumocytes hyperplasia.

Keywords: COVID-19; Pneumatocele; Pulmonary complication.

© The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Figures

Figure 1:

(A) Chest X-ray showing right side pneumothorax and lower lobe pneumatocele (blue arrow). (B) Chest X-ray showing chest drain in place, resolution of pneumothorax and lower zone pneumatocele with small fluid level. (C and D) Chest CT scan, axial and coronal views delineating the origin and extent of the pneumatocele; there are compression atelectasis of the medial aspect (white arrow), small fluid level and entrance of chest drain (black arrow).

Figure 2:

Histopathological studies of the resected roof of the pneumatocele showing, (A) Marked fibrosis and intra-alveolar haemorrhage (Hematoxylin and Eosin (H&E), ×200). (B) Hyperplasia of pneumocytes (H&E, ×400).