Spontaneous pneumothorax as unusual presenting symptom of COVID-19 pneumonia: surgical management and pathological findings

Bellini, Roberto; Salandini, M.C.; Cuttin, Serena; Mauro, Stefania Di; Scarpazza, Paolo; Cotsoglou, Christian

doi:10.1186/s13019-020-01343-4

Cited by 15 publications

(13 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…1 ). Articles and case descriptions with as much information as possible were selected for analysis; therefore, not all case studies were selected [ [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] ...…”

Section: Methodsmentioning

confidence: 99%

Pneumothorax due to COVID-19: Analysis of case reports

Gaytán¹,

Andrade²,

Valenzo³

2021

Respiratory Medicine Case Reports

View full text Add to dashboard Cite

Cases of pneumothorax/pneumomediastinum have been reported in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); however, the time to onset and hospital stay have rarely been studied. Coronavirus disease 2019 (COVID-19) patients with these complications are described to determine the time to onset, associated comorbidities, and location and duration of pneumothorax. A search in PubMed yielded simple frequencies and a bivariate analysis of deaths. There were 113 confirmed cases in 67 articles. The median time from the date of hospital admission to the presence of pneumothorax was 8 days. Right hemithorax was the most frequent form of pneumothorax. Almost half of the patients required intubation for invasive mechanical ventilation. Although the frequency of this phenomenon was not high among hospitalized patients with confirmed SARS-CoV-2, it was high among those who developed acute respiratory distress syndrome (ARDS). This study contributes to the literature because it presents a large number of patients who developed pneumothorax after admission, which was characterized by clinical deterioration (dyspnea, tachypnea, pleuritic chest pain, and subcutaneous emphysema) and low oxygen saturation levels. Pneumothorax/pneumomediastinum is recommended as a differential diagnosis, even without considering the presence of chronic pulmonary comorbidities or invasive mechanical ventilation.

show abstract

Section: Methodsmentioning

confidence: 99%

Pneumothorax due to COVID-19: Analysis of case reports

Gaytán¹,

Andrade²,

Valenzo³

2021

Respiratory Medicine Case Reports

View full text Add to dashboard Cite

show abstract

“…In addition to tissue sealants used by the surgeon, limiting positive pressure can reduce strain on staple lines and reduce potential air leak. It is also worth considering that COVID-19damaged lung tissue may not re-expand as expected, as noted by Bellini and colleagues [46]. Another suggested, but not widely endorsed, method of lung re-expansion is moderate chest drain suction to provide intrathoracic negative pressure under thoracoscopic guidance after surgical closure [31].…”

Section: Lung Re-expansionmentioning

confidence: 95%

“…1e ) [ 25 •, 28 ]; this avoids aerosol release from the airway but may cause a persistent air leak into the operative field through any parenchymal breach, exposing the operative staff to aerosolisation. There are reports of safe one-lung ventilation in patients with COVID-19 lung disease [ 46 ]; however, it might be expected that OLV would be challenging in patients with severe lung disease and may result in intolerable hypoxemia or hypercapnia [ 26 •]. Van den Eynde and colleagues advise against one-lung ventilation in all patients with COVID-19 diseased lungs due to these risks [ 47 ].…”

Section: One-lung Ventilationmentioning

confidence: 99%

Anesthetic Management for Thoracic Surgery During the COVID-19 Pandemic

Fraser

Steven

McCall

et al. 2021

Curr Anesthesiol Rep

View full text Add to dashboard Cite

Purpose of Review This review explores recent international guidance on the anesthetic management of patients undergoing thoracic surgery during the COVID-19 pandemic: those with suspected or confirmed COVID-19 requiring urgent thoracic surgery and those presenting for elective procedures. Recent Findings A significant mortality risk is associated with patients with COVID-19 undergoing thoracic surgery; therefore, where possible, it should be avoided. Thoracic surgery also carries a significant risk of viral transmission to healthcare workers due to the necessarily high frequency of intraoperative aerosol-generating procedures involved, such as lung isolation, one-lung ventilation, and flexible bronchoscopy. Summary Guidelines recommend appropriate personal protective equipment and numerous procedural modifications to prevent viral transmission to staff and other patients. With appropriate disease mitigation strategies in place, elective thoracic surgery, in particular for lung cancer, has been able to continue safely in many centres.

show abstract

“…Limited data is available for management of COVID-19 patients with spontaneous pneumothorax (SPTX) [2]. Medical management alone may be related to prolonged hospitalization, intubation, and additional complications [3,4]. Here, we present a COVID-19 patient with bilateral SPTX treated successfully with thoracoscopy and bleb resection.…”

Section: Introductionmentioning

confidence: 99%

Management of Bilateral Spontaneous Pneumothorax Related to COVID-19 Infection

Greene¹,

Gardner²,

Tipton³

et al. 2021

JCSR

View full text Add to dashboard Cite

Spontaneous pneumothorax is a rare but potentially fatal complication of coronavirus infection and COVID-19 pneumonia. Data is limited to guide clinicians in the setting of spontaneous pneumothorax when conservative management fails and operative intervention is required. We report the clinical course and operative strategy for a patient who presented with sequential bilateral spontaneous pneumothorax after being diagnosed with severe COVID-19 pneumonia. Conservative management with bilateral tube thoracostomies failed to resolve persistent alveolar-pleural fistulae, and ultimately the patient recovered after synchronous bilateral VATS blebectomies in the operating room. The timing and treatment of spontaneous pneumothorax requires follow-up education and surveillance for patients with this disease, as lack of prompt treatment outside the hospital could increase patient mortality. Spontaneous pneumothorax is a concern in patients who re-present with recurrent symptoms after COVID-19 diagnosis. When conservative treatment fails, surgery can safely be performed in COVID-19 patients with simultaneous bilateral pneumothorax with full functional recovery.

show abstract

Spontaneous pneumothorax as unusual presenting symptom of COVID-19 pneumonia: surgical management and pathological findings

Cited by 15 publications

References 13 publications

Pneumothorax due to COVID-19: Analysis of case reports

Pneumothorax due to COVID-19: Analysis of case reports

Anesthetic Management for Thoracic Surgery During the COVID-19 Pandemic

Management of Bilateral Spontaneous Pneumothorax Related to COVID-19 Infection

Contact Info

Product

Resources

About