Abstract | December 19, 2022

Rare Fatal Post COVID complication- Hydropneumothorax with Tension Pneumothorax

Presenting Author: Sucheta Kundu, MD, Internal Medicine Resident PGY3, Department of Medicine, North Alabama Medical Center, Florence, Alabama

Coauthors: Ayan Kumar, MD, Observer, Wilson Park Medical office building and NAMC, AL Megha Aggarwal, MD, PGY2, NAMC, AL; Felix Morris, MD, Pulmonologist, NAMC and Wilson Park Medical office building, AL

Learning Objectives

  1. Development of tension pneumothorax or hydro-pneumothorax following covid-19 infection is a marker of poor prognosis.
  2. Patients who develop ARDS resulting from these complications have worse prognosis. They typically become resistant to chest tube drainage and require thoracotomy/ VATS to recover.
  3. Incidence of pneumothorax is around 1-2% in covid 19 patients who don’t require intubation and up to 15% in patients requiring mechanical ventilation.

Introduction: Covid can result in variety of pulmonary and non-pulmonary complications. Pneumothorax especially tension pneumothorax, hydro-pneumothorax and pneumatocoeles are relatively rare yet fatal complications. Here we report such a case who developed tension pneumothorax and loculated hydro-pneumothorax following Covid pneumonia.

 

Case: Our patient is a 59 year old man who presented with complaint of increasing dry cough and shortness of breath for past 4 days. Before this he was treated for covid 2 weeks prior. He was saturating at 74% on room air and required 15L via non re-breather mask to maintain spo2 above 90%. Chest X-ray (CXR) showed right sided pneumothorax and 24G chest tube was put and connected to water seal. Following CXR showed improvement with lung expansion, patient’s work of breathing improved and he was transitioned to nasal cannula at 5L. After couple of days, patient’s respiratory distress worsened- requiring vapotherm for oxygenation and also developed hypotension. CXR showed tension pneumothorax and a second chest tube was placed immediately. Patient was intubated. CT chest showed development of loculated hydro-pneumothorax on the same side. CTVS was consulted as patient was not improving with chest tubes. As per their advice, patient needed VATS but he was too unstable for the same. Unfortunately patient passed away with the above complications despite best of our efforts.

 

Discussion: Incidence of pneumothorax is around 1-2% in covid 19 patients who don’t require intubation and up to 15% in patients requiring mechanical ventilation.  However tension pneumothorax is extremely rare and possibly fatal complication of covid-19 pneumonia. Similarly incidence of hydro-pneumothorax in patients with no prior incidence of lung diseases is also quite rare. Multiple mechanisms are attributed to these associations. Patients who develop ARDS resulting from these complications, as seen in our patient have worse prognosis. They typically become resistant to chest tube drainage and require thoracotomy/ VATS to recover.

 

Conclusion: Development of tension pneumothorax or hydro-pneumothorax following covid-19 infection is a marker of poor prognosis. Hence suspicion threshold should be kept low in identifying these conditions so that timely treatment can prevent development of ARDS and help in avoiding operative complications.

 

References:

  1. Vardhan B, Biswas P, Chatterjee S, et al. Post COVID-19 pulmonary ventilation and tension pneumothorax in a non ventilated patient. Journal of family medicine and primary care. 2022:11(4).

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