Spontaneous pneumothorax as unusual presenting symptom of COVID-19 pneumonia: surgical management and pathological findi
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(2020) 15:310
CASE REPORT
Open Access
Spontaneous pneumothorax as unusual presenting symptom of COVID-19 pneumonia: surgical management and pathological findings Roberto Bellini1†, Maria Chiara Salandini1*† , Serena Cuttin2, Stefania Mauro3, Paolo Scarpazza4 and Christian Cotsoglou1
Abstract Background: Spontaneous pneumothorax has been reported as a possibile complication of novel coronavirus associated pneumonia (COVID-19). We report two cases of COVID-19 patients who developed spontaeous and recurrent pneumothorax as a presenting symptom, treated with surgical procedure. An insight on pathological finding is given. Case presentation: Two patients presented to our hospital with spontaneous pneumothorax associated with SarsCov2 infection onset. After initial conservative treatment with chest drain, both patients had a recurrence of pneumothorax during COVI-19 disease, contralateral (patient 1) or ipsilateral (patient 2) and therefore underwent lung surgery with thoracoscopy and bullectomy. Intraoperative findings of COVID-19 pneumonia were parenchymal atelectasis and vascular congestion. Lung tissue was very frail and prone to bleeding. Histological examination showed interstitial infiltration of lymphocytes and plasma cells, as seen in non specific interstitial pneumonia, together with myo-intimal thicknening of vessels with blood extravasation and microthrombi. Conclusions: Although rarely, COVID-19 may present with spontaneous pneumothorax. Lung surgery for pneumothorax in COVID-19 patients can be safely and effectively performed when necessary. Keywords: Pneumothorax, COVID-19, Thoracoscopy, Case report, Bullectomy, Pathology
Introduction On December 2019, a novel coronavirus-related pneumonia has been first reported in the city of Wuhan, China [1]. Since then, the disease has spread worldwide throughout Asia, Europe, America and Africa. In Italy, the first cases of novel coronavirus infections were reported on February 21, 2020. * Correspondence: [email protected] † Roberto Bellini and Maria Chiara Salandini contributed equally to this work. 1 Department of Surgery, General Surgery Division, Vimercate Hospital, Vimercate, Italy Full list of author information is available at the end of the article
Patients with COVID-19 can have mild symptoms such as fever, cough, fatigue and smell and taste dysfunction, or more serious and rapidly progressing respiratory impairment such as Acute Respiratory Distress Syndrome [2, 3]. Radiological presentation at CT scan is characterized by bilateral interstitial infiltrates with ground glass opacities (GGO), multiple lobar and subsegmental consolidations and air bronchograms [4]. Other findings such as pleural effusion, cavitation, pneumomediastinum and pneumothorax are uncommon and in some cases anecdotal [4–6].
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give
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