Giant lung bulla as a late-onset complication of mild SARS-CoV-2 pneumonia

A 49-year-old Caucasian man was admitted to the Emergency Department for shortness of breath and cough. Computed tomography (CT) imaging showed bilateral mild COVID-19-related pneumonia. He was hospitalized in the low-intensity COVID-19 unit, where he received O2 therapy and oral corticosteroids. Three weeks after discharge, a high-resolution CT (HRCT) found a giant bulla in the inferior lobe. The bulla was resected by video-assisted thoracoscopic surgery, and the patient recovered completely. In our patient, it is reasonable to suspect that the development of the bulla is a result of SARS-CoV-2 infection since no bulla was observed in the first HRCT two months before. SARS-CoV-2-related pneumonia may be responsible for lung remodeling due to diffuse alveolar damage and later interstitial myofibroblastic proliferation. Corticosteroids might have played a role in increasing SARS-CoV-2 dystrophic action. COVID-19 leads to pulmonary damages, which are still partially unknown and might result in the development of bullae. In fit patients, surgical treatment can be carried out safely.