From the Guidelines
Spontaneous pneumothorax is a potential complication of COVID-19 infection, particularly in critical patients requiring invasive ventilation, and should be promptly evaluated and managed to minimize morbidity and mortality. The relationship between spontaneous pneumothorax and COVID-19 is supported by anecdotal reports of spontaneous pneumothorax and pneumomediastinum drainage in COVID-19 patients 1. Patients with COVID-19 who develop sudden chest pain, worsening shortness of breath, or respiratory distress should be evaluated immediately for possible pneumothorax.
Diagnosis and Management
Diagnosis of pneumothorax in COVID-19 patients requires chest imaging, typically a chest X-ray or CT scan. Management depends on the size of the pneumothorax and the patient's clinical condition. Small, stable pneumothoraces may be managed conservatively with supplemental oxygen and close monitoring. Larger pneumothoraces typically require chest tube placement for air evacuation, using a small-bore (8-14 French) or large-bore (16-28 French) tube depending on the clinical situation.
Considerations in COVID-19 Patients
The development of pneumothorax in COVID-19 patients is thought to result from alveolar damage caused by viral infection, barotrauma from mechanical ventilation in severe cases, or cystic changes in the lung parenchyma 1. These patients should be monitored closely as they have higher morbidity and mortality compared to non-COVID pneumothorax patients, and may require longer hospitalization and supportive care. It is crucial to take precautions during pleural procedures, considering them as potential Aerosol Generating Procedures (AGP), and wearing Level 2 PPE to minimize the risk of transmission 1.
Key Points
- Spontaneous pneumothorax is a potential complication of COVID-19 infection
- Prompt evaluation and management are necessary to minimize morbidity and mortality
- COVID-19 patients with pneumothorax require close monitoring and may need longer hospitalization and supportive care
- Precautions should be taken during pleural procedures to minimize the risk of transmission 1
From the Research
Relationship between Spontaneous Pneumothorax and COVID-19
- Spontaneous pneumothorax has been reported as a rare complication of COVID-19 pneumonia 2, 3, 4.
- The occurrence of spontaneous pneumothorax in COVID-19 patients might be higher than expected, and clinicians should be aware of this potential complication 3.
- Spontaneous pneumothorax can be an overlooked complication of COVID-19 and may be associated with poor prognosis 3.
- COVID-19 patients who develop spontaneous pneumothorax often have underlying lung disease, such as pneumonia, and may require oxygen therapy 3, 4.
- Surgical management, including closed thoracic drainage and lung surgery, may be necessary for patients with spontaneous pneumothorax due to COVID-19 4.
Clinical Presentations and Outcomes
- Patients with COVID-19 who develop spontaneous pneumothorax may present with shortness of breath, chest pain, and fever 2, 3.
- The diagnosis of spontaneous pneumothorax in COVID-19 patients can be made using radiographic imaging, such as chest X-ray and CT scan 2, 3, 5.
- The outcome of patients with spontaneous pneumothorax due to COVID-19 can be poor, with a high mortality rate 3.
- However, some patients can recover smoothly with appropriate treatment, including chest tube insertion and supplemental oxygen 3, 5.
Pathological Findings
- Histological examination of lung tissue from COVID-19 patients with spontaneous pneumothorax has shown interstitial infiltration of lymphocytes and plasma cells, as well as myo-intimal thickening of vessels with blood extravasation and microthrombi 4.
- The lung tissue of COVID-19 patients with spontaneous pneumothorax can be frail and prone to bleeding 4.