By Katelyn Stark, Jesse Lamb, Marina Louka, Diana Artiles, Kholtyn Barney, Tanya Dabra
A 58-year-old male patient with a history of prostate enlargement and COVID-19 was brought to the Emergency Department with severe shortness of breath. The patient had been discharged from the hospital after being treated for COVID-19 approximately seven days earlier as his COVID-19 related symptoms had improved. He was conscious at presentation and was able to communicate with the emergency physician. The patient described experiencing increasing dyspnea for the past three days, which suddenly worsened with additional chest pain a few hours before presentation. Physical examination revealed a left-deviated trachea, and the right side of the chest had absent tactile fremitus, tympany to percussion, and absent breath sounds on auscultation. Chest X-Ray followed by chest CT revealed a large right sided pneumothorax with mediastinum and trachea shifted to the left side with small pleural effusion and large ground glass opacities in the left lung. Lab tests were significant for elevated D-dimer, and Arterial Blood Gas (ABG) results showed decreased partial oxygen pressure (PaO2: 47 mmHg), increased partial carbon dioxide pressure (PaCO2: 59 mmHg), and low oxygen saturation on room air (SpO2: 92%), indicating borderline respiratory failure. Initial effort to insert a drainage tube was unsuccessful as it bent on the chest wall but a second effort by repositioning the drainage tube was successful at removing the air from the pleural cavity. The patient’s dyspnea and chest pain dramatically improved following the procedure. The patient was put on a mask with 100% oxygen and SpO2 eventually increased to 98%. The patient was admitted to surgical ward (post operating room) and was monitored for any changes in status.
Spontaneous pneumothorax is a rare occurrence in patients with COVID-19 disease. Given the medical emergency associated with pneumothorax, it is essential that physicians are aware of this complication in patients treated for COVID-19 for better overall patient outcome.