Rapidly developing large pneumatocele and spontaneous pneumothorax in SARS-CoV-2 infection

Abstract

Coronavirus disease 2019 (COVID-19) has spread to more than 70 countries around the world since its discovery in 2019. More than 2.5 million cases and more than 130,000 deaths have been reported in the United States alone. The common radiological presentation in this disease is noted to be the presence of ground glass opacities and/or consolidations. We report a case of 40-year-old male admitted for COVID-19 and rapidly deteriorated into severe acute respiratory distress syndrome requiring intubation and mechanical ventilation with no prior history of smoking or lung disease. The patient had normal imaging 3 days prior to admission to the hospital and rapidly developed a large pneumatocele with pneumothorax requiring chest tube placement that later on resolved. This is a unique radiologic finding in COVID-19 and likely related to severe inflammation secondary to SARS-CoV-2 infection.

Keywords: ARDS; COVID-19; Pneumatocele; Pneumothorax; SARS-CoV-2.

Conflict of interest statement

Are there any relevant conflicts of interest? NO. Relevant financial activities outside submitted work: None. No other relationships/conditions/circumstances that present a potential conflict of interest. All authors read the manuscript and approved for submission.

© 2020 The Author(s).

Figures

Fig. 1

Chest X-ray on first admission showing diffuse reticular markings with bilateral airspace opacities.

Fig. 2

Chest X-ray on second admission showing moderate to large sized right sided pneumothorax with right middle lobe pneumatocele and worsening bilateral airspace opacities (on left) and expanded lung post pig tail catheter placement (on right).

Fig. 3

CT thorax showing multi focal bilateral ground-glass opacities and a 7.3 × 6.6 cm pneumatocele in mid right posterior hemi thorax in axial view (on left) and coronal view (on right).

Fig. 4

Chest X-ray 3 month from admission showing near complete resolution of pneumatocele.