DISCUSSION: There is one previous case report that hypothesized the development of pneumothorax as an early manifestation of OSA. Whereas some patients with COVID-19 developed pneumothorax in association with risk factors, such as mechanical ventilation, in others the only factor was the viral pneumonia itself 19. Sign In to Email Alerts with your Email Address, COVID-19 and Pneumothorax: A Multicentre Retrospective Case Series, Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study, Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study, Analysis of 92 deceased patients with COVID-19, High Incidence of Barotrauma in Patients with COVID-19 Infection on Invasive Mechanical Ventilation, Pneumomediastinum and spontaneous pneumothorax as an extrapulmonary complication of COVID-19 disease, COVID-19 with spontaneous pneumomediastinum, Pneumomediastinum following intubation in COVID-19 patients: a case series, Severe acute respiratory syndrome complicated by spontaneous pneumothorax, Acute Middle East Respiratory Syndrome Coronavirus: Temporal Lung Changes Observed on the Chest Radiographs of 55 Patients, Guidelines on the management of acute respiratory distress syndrome, Trends in the Incidence and Recurrence of Inpatient-Treated Spontaneous Pneumothorax, 1968–2016, Population estimates for the UK, England and Wales, Scotland and Northern Ireland: mid-2019, Date last updated: August 27, 2020. Conflict of interest: Dr. Iqbal has nothing to disclose. Inclusion criteria were limited to a diagnosis of COVID-19 and the presence of either pneumothorax or pneumomediastinum, with patients presenting between March and the beginning of June 2020, allowing for ≥28 days of follow-up post-pneumothorax in each case. Despite including cases from only 16 of the UK's more than 150 hospital trusts, our case series is already substantially in excess of this estimate. Conflict of interest: T. Ingle has nothing to disclose. Pneumothorax is air around or outside the lung. Available from, Date last updated: May 21, 2020. Pneumothorax is a rare complication of viral infections and there is no evidence that previous pneumothorax would put you more at risk unless you have another underlying lung condition. While the lower survival rate noted in intubated patients was not statistically significant, larger studies or meta-analyses may be able to further address this. Although heterogeneous, these cases provide important insights into the association between pneumothorax and COVID-19. Coronavirus disease 2019 (COVID-19) infection is a global infection that affects many countries. Conflict of interest: J. Babar has nothing to disclose. Conflict of interest: R. Mahroof has nothing to disclose. Pneumonia is a potential complication of COVID-19. Indeed, previous reports describe intubated patients with COVID-19 developing pneumothorax refractory to chest drain insertion which ultimately required surgery . The current literature consists primarily of single case reports, with the largest published series comprising three patients who died with COVID-19 and pneumomediastinum, two of whom also had pneumothorax . Additionally, a 15 mm cystic space was identified grossly within the parenchyma; histologic sections showed a dense fibrous cyst wall lined by bland cuboidal cells (fig. Typically, plain chest films provided no additional cause for the pneumothorax apart from concomitant COVID-19 (figure 1a). b) Axial computed tomography image of the thorax acquired in a COVID-19 patient shortly before development of a right-sided pneumothorax. The trapped air in the pleural space prevents your lung from filling with air, and the lung collapses. Marciniak is supported by the Medical Research Council, Cambridge BRC, Royal Papworth Hospital and the Alpha1-Foundation. Conflict of interest: Dr. Lee has nothing to disclose. Conflict of interest: Dr. Huang has nothing to disclose. Eduardo Sanchez, M.D., M.P.H., FAAFP, the American Heart Association’s Chief Medical Officer for Prevention, shares advice and resources for patients and others concerned about the coronavirus. Four cases had pneumomediastinum in addition to pneumothorax. Therefore, these The incidence of pneumothorax was higher in males. It happens if air collects in the pleural space (the space between your lungs and chest wall). Survival at 28 days was not significantly different following pneumothorax (63.1±6.5%) or isolated pneumomediastinum (53.0±18.7%; p=0.854). Our study aims to describe the clinical characteristics of patients with these pathologies and consider whether development of pneumothorax can be used as a marker of poor prognosis. Conflict of interest: S. Trenfield has nothing to disclose. A 36-year-old man was brought to the emergency department with suspected COVID-19, following a 3-week history of cough, fevers and shortness of breath, worsening suddenly in the preceding 4 hours. c) Medium-power photomicrograph of lung parenchyma showing foci of collapse with accompanying fibrosis and vascular congestion. 11 patients required chest drains to be inserted, one of whom required right upper lobe bullectomy, as described earlier. This version is distributed under the terms of the Creative Commons Attribution Licence 4.0. Therefore, it is important that clinicians be provided with appropriate personal protective equipment for aerosol-generating procedures during chest drain insertion and that consideration is given to droplet-minimising modifications to the procedure, including digital drainage systems, connection of the drainage circuit to wall suction and the use of filters to limit viral spread [25, 26]. Martinelli: conceptualisation, methodology, formal analysis, investigation, writing – original draft, visualisation, project administration. Our series suggests the complication of pneumothorax is more prevalent in males (3.3:1); large series of patients with COVID-19 suggest that males are more commonly affected by severe forms the disease, which may account for this observation . Management of pneumothorax in patients with ARDS who are being invasively ventilated can represent a clinical challenge. Conflict of interest: Dr. Davies has nothing to disclose. Cases were collected retrospectively based on a combination of author recall and targeted review of hospital coding databases from across the UK. Log-rank test comparing (a) and (b) p=0.854. Previous autopsy findings in COVID-19 patients reveal bilateral diffuse alveolar damage with cellular fibromyxoid exudates, which may cause a ball-valve effect when impacted in bronchioles, resulting in cystic changes. Indeed, previous reports describe intubated patients with COVID-19 developing pneumothorax refractory to chest drain insertion which ultimately required surgery . A spontaneous pneumothorax can happen in one or both lungs. Details obtained from the medical record included demographics (ages were limited to bands of one decade to maintain patient anonymity), past medical history, laboratory investigations (including full blood count, C-reactive protein and D-dimer), radiological findings (chest radiograph and computed tomography (CT)), clinical management, patient progress, and survival (tables 1 and 2, Supplementary Tables S1 and S2). Date last accessed: 6 July 2020, Chest imaging appearance of COVID-19 infection, COVID-19 with cystic features on computed tomography: a case report, Mediastinal emphysema, giant bulla, and pneumothorax developed during the course of COVID-19 pneumonia, Late-stage adult respiratory distress syndrome caused by severe acute respiratory syndrome: abnormal findings at thin-section CT, Pneumothorax and mortality in the mechanically ventilated SARS patients: a prospective clinical study, Management of persistent pneumothorax with thoracoscopy and blebs resection in COVID-19 patients, Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010, Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study, Intensive Care National Audit & Research Centre (ICNARC), Report on COVID-19 in Critical Care – 03 July 2020 Date last updated: July 3, 2020. b) Axial CT image of the thorax acquired in a COVID-19 patient shortly before development of a right-sided pneumothorax. J. Newman, I. Nadeem, K. Jackson, N.D. Lane, J. Melhorn, H.E. This air pushes on the outside of your lung and makes it collapse. Details obtained from the medical record included demographics, radiology, laboratory investigations, clinical management and survival. Two patients had two distinct episodes of pneumothorax, occurring bilaterally in sequential fashion, bringing the total number of pneumothoraces included to 62. A significant relationship remained after inclusion of non-ventilated patients for whom blood gas were available (acidotic 33.3%±10.8%; not acidotic 83.3%±7.6%; p=0.001; fig. Sign In to Email Alerts with your Email Address, COVID-19 and pneumothorax: a multicentre retrospective case series, Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study, Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study, Analysis of 92 deceased patients with COVID-19, High incidence of barotrauma in patients with COVID-19 infection on invasive mechanical ventilation, Pneumomediastinum and spontaneous pneumothorax as an extrapulmonary complication of COVID-19 disease, COVID-19 with spontaneous pneumomediastinum, Pneumomediastinum following intubation in COVID-19 patients: a case series, Severe acute respiratory syndrome complicated by spontaneous pneumothorax, Acute Middle East respiratory syndrome coronavirus: temporal lung changes observed on the chest radiographs of 55 patients, Guidelines on the management of acute respiratory distress syndrome, Trends in the incidence and recurrence of inpatient-treated spontaneous pneumothorax, 1968–2016, Population Estimates for the UK, England and Wales, Scotland and Northern Ireland: Mid-2019, Date last updated: 27 August 2020. 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Low-Power view of the Creative Commons Attribution Licence 4.0 collected retrospectively based on a general or respiratory ward intervention pneumomediastinum!
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