Spontaneous hemopneumothorax in a patient with COVID-19

Abstract

Coronavirus disease 2019 (COVID-19) is primarily a febrile respiratory illness that was first documented in China in December 2019 and shortly after declared a pandemic on March 11, 2020. The pathophysiology of the virus is still not completely understood and remains under investigation. Consequently, new symptomatic manifestations and complications of the disease continue to be discovered. Here we present the case of a spontaneous hemopneumothorax resulting in hemorrhagic shock in an adult male with PCR confirmed COVID-19.

COVID-19 and the World with Co-Morbidities of Heart Disease, Hypertension and Diabetes

“…Mononuclear infiltration in the myocardium, and associated cardiomyocyte necrosis 41 leading to, acute lung injury and acute respiratory distress syndrome (ARDS) result in strain on right side of heart and right ventricular (RV) dilation and dysfunction. The resultant elevated positive end expiratory pressure (PEEP) in the patient on ventilation can also deteriorate heart function 42 .…”

Pituitary apoplexy in the setting of COVID-19 infection

“…Typical COVID-19 infections are associated with lung injury as well as proinflammatory/thrombotic states such as pulmonary embolus [ 3 ]. To date, there are few reports of spontaneous bleeding or neurological manifestations in the setting of COVID-19, although myelitis and acute necrotizing hemorrhagic encephalopathy have been reported [ 12 , 13 ]. While apoplexy has been linked to increases in ICP caused by coughing and sneezing [ 14 ], there is emerging literature on bleeding diathesis due to COVID-19.…”

Renal angiomyolipoma rupture in a young female with COVID-19

“…Other spontaneous bleeding complications have been described after infection with COVID-19, such as retroperitoneal hematoma, gastrointestinal bleeding, hemopneumothorax, and cerebral hemorrhage. 4,5,8,16,17 Proposed mechanisms of COVID-associated coagulopathy include direct infection of endothelial cells via ACE-2 receptors and delayed autoantibody development against endothelial cells. 19,20 Prolonged PT, APTT, and INR and elevated D-dimer are associated with poor COVID-19 outcomes and can be considered by EM physicians concerned for a COVID-related coagulopathy.…”

“…The patient had none of the previously mentioned risk factors, including pregnancy, aneurysm, or AML size greater than 4 cm. Other spontaneous bleeding complications have been described after infection with COVID-19, such as retroperitoneal hematoma, gastrointestinal bleeding, hemopneumothorax, and cerebral hemorrhage [ 4 , 5 , 8 , 16 , 17 ]. Proposed mechanisms of COVID-associated coagulopathy include direct infection of endothelial cells via ACE-2 receptors and delayed autoantibody development against endothelial cells [ 19 , 20 ].…”

“…While primarily a respiratory illness, infection with the novel coronavirus (COVID-19) is associated with both thromboembolic and bleeding events [ [1] , [2] , [3] , [4] , [5] ]. The pathologic clotting associated with COVID-19 has been established in the literature, however, there is emerging data suggesting a concomitant risk of hemorrhage.…”