Secondary spontaneous pneumothorax as postCOVID-19 sequela

Abstract

A 48-year-old male patient with a significant history of hypertension for 8 years and newly diagnosed diabetes was admitted on account of fever and difficulty in breathing from 15 days, initially exertional but later present at rest. A nasopharyngeal swab taken for reverse transcription polymerase chain reaction (RT-PCR) testing was positive for COVID-19. Following admission, he was placed on 15 L O₂/min because of not maintaining saturation later put on a mechanical ventilator on pressure support mode with positive end-expiratory pressure (PEEP) 8 cm H₂O and 80% FiO₂ for the next 8 days. High-resolution computed tomography (HRCT) thorax (A) revealed multiple areas of ill-defined ground-glass opacities with septal thickening and few areas of consolidation. There are multiple air-filled cystic spaces (red arrow) in sub-pleural spaces of lateral segment of right middle and lower lobes there is evidence of fibro-bronchiectatic changes as a symptom of Post-COVID sequela with CT severity score 23/25 (severe) and CORAD-6. Later he was put on BiPAP support for 19 days and gradually weaned off to 12L O₂/min via face mask connecting to re-breathing bag. Soon he developed secondary spontaneous pneumothorax visible on chest X-ray (B) because of which pig tail inter-costal drainage was done in 4^th intercostal space in anterior axillary line. Post COVID-19 complications are become more evident and chest imaging plays an important role in early screening and monitoring such cases.