Pulmonary cavitation: an under-recognized late complication of severe COVID-19 lung disease

Abstract

Background Pulmonary radiological findings of the novel coronavirus disease 2019 (COVID-19) have been well documented and range from scattered ground-glass infiltrates in milder cases to confluent ground-glass change, dense consolidation, and crazy paving in the critically ill. However, lung cavitation has not been commonly described in these patients. The objective of this study was to assess the incidence of pulmonary cavitation in patients with COVID-19 and describe its characteristics and evolution. Methods We conducted a retrospective review of all patients admitted to our institution with COVID-19 and reviewed electronic medical records and imaging to identify patients who developed pulmonary cavitation. Results Twelve out of 689 (1.7%) patients admitted to our institution with COVID-19 developed pulmonary cavitation, comprising 3.3% (n = 12/359) of patients who developed COVID-19 pneumonia, and 11% (n = 12/110) of those admitted to the intensive care unit. We describe the imaging characteristics of the cavitation and present the clinical, pharmacological, laboratory, and microbiological parameters for these patients. In this cohort six patients have died, and six discharged home. Conclusion Cavitary lung disease in patients with severe COVID-19 disease is not uncommon, and is associated with a high level of morbidity and mortality.

Simultaneous Giant cavity pulmonary lesion and pneumothorax following COVID-19 pneumonia

“…Classic COVID-19 pneumonia presents with GGO and CLO, predominantly in the lower lung lobes, without cavitary lesions, pneumothorax, lymphadenopathy and pleural effusion [ 3 , 4 , 7 , 8 ]. Complications of COVID-19 pneumonia can still arise over time and cavitary lung lesions (also of gigantic size) as well as pneumothorax have also been reported [ 2 , 4 , [9] , [10] , [11] , [12] , [13] ]. Nevertheless, a simultaneous pneumothorax as well as cavitary lung formation is an exceptional and idiopathic feature.…”

“…Idiopathic cavitary pulmonary lesions and pneumothorax are rare complications reportedly affecting a small proportion of COVID-19 patients [2] , [3] , [4] , [5] , [6] ,…”

COVID-19 pneumonitis and cystic lung disease, pneumothorax and pneumomediastinum

“…1 A rare yet under-recognised complication is that these cystic areas may progress to bullae, cavities and pneumothoraces. 2 Cavities can occur secondary to bacterial or fungal infections 3 and fungal infections may be associated with subpleural cysts and pneumothorax. However, the CRP <10 and procalcitonin of 0.04-0.18 did not support this, though a beta-D glucan was not sent.…”

Post-COVID syndrome: pulmonary complications

“…In a series of 12 cases (1.7%) within the 689 COVID-19 pneumonia patient group reported by Zoumot Z et al, the mean time from the first symptom onset to the detection of cavitation was 36 days, and all patients had bilateral peripheral ground glass opacities on their first chest tomography. Consolidation and air bronchograms were detected in most of the patients and cobblestone appearance with interlobular septal thickenings in half of them [55]. Tocilizumab and steroid therapy, which cause immunosuppression, were administered to patients followed up in the intensive care unit with severe COVID-19 pneumonia, but bacterial agents that could cause cavitary lesions were detected in only 4 patients.…”

“…The authors describe the development of cavitation in these patients as a result of multifactorial reasons such as: bacterial and fungal coinfection, immunosuppressive effects of glucocorticosteroids and tocilizumab, inflammatory pathways specific to SARS-CoV-2, susceptibility to COVID-19 related venous thromboembolism and micro-infarctions or infarctions causing cavitary lesions. They also emphasized that the natural course of these cavities in survivors is uncertain [55].…”