Pneumothorax in 2019 novel coronavirus pneumonia needs to be recognized
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Pneumothorax in 2019 novel coronavirus pneumonia needs to be recognized Wenya Li1 · Shun Xu1 · Peiwen Li1 · Guan Wang2 · Zhenning Wang3 Received: 25 June 2020 / Accepted: 25 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
To the Editor, We read with interest the article recently published by Judith E. Spiro et al. [1] describing a case of secondary tension pneumothorax in a 2019 novel coronavirus pneumonia (COVID-19) patient. Similarly, we treated a male patient aged 77 years, who was diagnosed with COVID-19 based on computed tomography (CT) and positive RT-PCR findings. On the 10th day after admission the patient was intubated and needed mechanical ventilation due to acute respiratory distress syndrome. Just 7 h later, a sudden drop in oxygen saturation (SO2) from 98 to 83% was discovered. Thus, pneumothorax was suspected, and a tension pneumothorax was soon confirmed by bedside chest radiography. Immediate drainage with a chest tube was successfully established and the patients’ SO2 returned to normal. Unfortunately, the patient died of multiple organ failure on the 19th day in hospital. The outbreak of COVID-19 has developed from a global concern to a global threat and health emergency due to the rapidly growing number of cases both in China and internationally. During this epidemic crisis, ordinary conditions, such as pneumothorax, may have been neglected. Commonly, the overall incidence of spontaneous pneumothorax has been reported to be 17–24 per 100 000 males and 1–6 per 100 000 females [2]. However, when considered in the COVID-19 population, the incidence can be 40- to hundreds-fold higher and was 1% (1/99) in a recent report [3] * Zhenning Wang [email protected] 1
Department of Thoracic Surgery, The First Hospital of China Medical University, Shenyang 110001, Liaoning, China
2
Department of Radiology, The First Hospital of China Medical University, Shenyang 110001, Liaoning, China
3
Department of Surgical Oncology, The First Hospital of China Medical University, No. 155 Nanjing North Road, Shenyang 110001, Liaoning, China
and 1.3% (1/75) among the inpatients treated in the intensive care isolation ward of Wuhan Union Hospital West Campus, which is supported by doctors from the 1st Hospital of China Medical University. A total of 26–32% of early COVID-19 patients were transferred to the intensive care unit (ICU), and up to 10–47.2% of severe patients received invasive ventilation [4, 5], which will theoretically increase the occurrence of pneumothorax and accelerate the progression of pneumothorax, resulting in tension pneumothorax and a life-threatening condition, as shown in our case and in other case reports [1, 3]. Based on not only its high incidence but also the severity of disease progression, pneumothorax in COVID-19 pneumonia patients should be given more attention. There is a bimodal age distribution for spontaneous pneumothorax, with one peak at 15–34 years and the other peak at older than 60 years in the overall population [2]. From a
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