COVID-19 Complicated by Spontaneous Pneumothorax

Area of Science:

• Pulmonology
• Infectious Diseases
• Critical Care Medicine

Background:

• The coronavirus disease 2019 (COVID-19) pandemic presents significant challenges to healthcare systems globally.
• While respiratory failure is common in severe COVID-19, pneumothorax is an infrequent complication, reported in approximately 1% of cases.

Observation:

• This case series describes three patients diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who presented with pneumothorax.
• These patients, treated within the New York City Health and Hospitals system, had no prior lung disease history, with one being a former smoker.
• Elevated inflammatory markers, consistent with severe COVID-19, were observed in all three patients.

Findings:

• Computed tomography (CT) scans revealed bilateral airspace disease indicative of COVID-19 pneumonia, alongside pneumothorax, pneumomediastinum, subcutaneous emphysema, and pneumatoceles.
• The findings suggest that inflammation-induced pulmonary parenchymal injury and necrosis may lead to air leaks, causing pneumothorax in COVID-19 patients, similar to mechanisms observed during the 2003 SARS outbreak.
• Two patients were managed conservatively with chest tube drainage or observation, while one experienced fatal multi-organ system dysfunction.

Implications:

• This case series expands the understanding of potential thoracic complications associated with COVID-19.
• The findings underscore the importance of considering pneumothorax in COVID-19 patients presenting with respiratory distress, particularly those with severe pneumonia and elevated inflammatory markers.
• Further research is warranted to elucidate the precise mechanisms and optimal management strategies for pneumothorax in the context of COVID-19.