Pneumatocele with an associated pneumothorax in a COVID-19 patient.
Pneumatocele, pneumothorax, COVID-19
A 49 y/o male with a history of unresolved COVID-19 infection presents with dyspnea and shortness of breath for the past 3 weeks. The dyspnea is moderate in severity with an associated 6/10 pleuritic, non-radiating chest pain. The patient denies any cough, fever, chills, nausea or vomiting. In the emergency department, the patient was found to be hemodynamically stable but hypoxic (O2 saturation 87% on room air), tachypneic (55 bpm), and tachycardic (160 bpm). Physical examination showed a well-nourished afebrile patient with tachypnea, decreased breath sounds in the lower lung fields, bilaterally. His chest x-ray on admission showed a moderate-large right pneumothorax with diffuse, bilateral airspace opacities and a right 8.4 cm x 4.3 cm marginated lucency (which was not evident on an x-ray from 3 weeks ago) (figure 1 and 2). The patient received a chest tube in the emergency department and was admitted to the ICU. On day 6 of admission the patient received a CT scan of the thorax without contrast that showed bilateral ground glass opacities and lower lobe consolidations. There was also a 7.6 cm x 7.1 cm thin walled cystic lesion in the mid-posterior right thorax with an air-fluid level, consistent with a pneumatocele (figure 3). On day 11 the patient coded due to a tension pneumothorax with considerable midline shift (figure 4), achieved return of spontaneous circulation. The patient’s chest tube was switched on and the pneumothorax had decreased in size and has been stabilized.