Rehnberg Lucas, Chambers Robert, Lam Selina, Chamberlain Martin, Dushianthan Ahilanandan
General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, Tremona Road, Southampton SO16 6YD, UK.
Cardiothoracic Radiology, University Hospital Southampton NHS Foundation Trust, Southampton, Tremona Road, Southampton SO16 6YD, UK.
Case Rep Crit Care. 2020 Sep 18;2020:8896923. doi: 10.1155/2020/8896923. eCollection 2020.
We present this case of a young woman with SARS-CoV-2 viral infection resulting in coronavirus 2019 (COVID-19) lung disease complicated by a complex hydropneumothorax, recurrent pneumothorax, and pneumatoceles. A 33-year-old woman presented to the hospital with a one-week history of cough, shortness of breath, and myalgia, with no other significant past medical history. She tested positive for COVID-19 and subsequently, her respiratory function rapidly deteriorated, necessitating endotracheal intubation and mechanical ventilation. She had severe hypoxic respiratory failure requiring a protracted period on the mechanical ventilator with different ventilation strategies and multiple cycles of prone positioning. During her proning, after two weeks on the intensive care unit, she developed tension pneumothorax that required bilateral intercostal chest drains (ICD) to stabilise her. After 24 days, she had a percutaneous tracheostomy and began her respiratory wean; however, this was limited due to the ongoing infection. Thorax CT demonstrated a left-sided pneumothorax, with bilateral pneumatoceles and a sizeable, complex hydropneumothorax. Despite the insertion of ICDs, the hydropneumothorax persisted over months and initially progressed in size on serial scans needing multiple ICDs. She was too ill for surgical interventions initially, opting for conservative management. After 60 days, she successfully underwent a video-assisted thoracoscopic surgery (VATS) for a washout and placement of further ICDs. She was successfully decannulated after 109 days on the intensive care unit and was discharged to a rehabilitation unit after 116 days of being an inpatient, with her last thorax CT showing some residual pneumatoceles but significant improvement. Late changes may mean patients recovering from the COVID-19 infection are at increased risk of pneumothoracies. Clinicians need to be alert to this, especially as bullous rupture may not present as a classical pneumothorax.
我们报告了一例年轻女性感染严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）导致2019冠状病毒病（COVID-19）肺病，并伴有复杂性液气胸、复发性气胸和肺气囊的病例。一名33岁女性因咳嗽、气短和肌痛一周入院，既往无其他重大病史。她的COVID-19检测呈阳性，随后呼吸功能迅速恶化，需要气管插管和机械通气。她患有严重的低氧性呼吸衰竭，需要在机械通气下采用不同的通气策略并多次进行俯卧位通气，持续较长时间。在重症监护病房住院两周后的俯卧位通气期间，她出现了张力性气胸，需要双侧肋间胸腔闭式引流（ICD）来稳定病情。24天后，她接受了经皮气管切开术并开始进行呼吸脱机；然而，由于持续感染，脱机受到限制。胸部CT显示左侧气胸，双侧肺气囊以及一个较大的复杂性液气胸。尽管插入了ICD，但液气胸持续数月且在系列扫描中最初体积增大，需要多次插入ICD。她最初病情太重无法进行手术干预，选择了保守治疗。60天后，她成功接受了电视辅助胸腔镜手术（VATS）进行冲洗并放置了更多的ICD。在重症监护病房住院109天后，她成功拔管，住院116天后出院至康复病房，最后一次胸部CT显示仍有一些残留的肺气囊，但病情有显著改善。后期变化可能意味着从COVID-19感染中康复的患者气胸风险增加。临床医生需要对此保持警惕，尤其是因为肺大疱破裂可能不会表现为典型的气胸。
