June Ciara, Viscusi Chad, DeLange Burke
Medicine, University of Arizona College of Medicine - Tucson, Tucson, USA.
Emergency Medicine, University of Arizona College of Medicine - Tucson, Tucson, USA.
Cureus. 2022 May 18;14(5):e25107. doi: 10.7759/cureus.25107. eCollection 2022 May.
Simultaneous bilateral spontaneous pneumothorax is a rare life-threatening condition that can cause severe respiratory distress, hypoxemia, and death. Spontaneous pneumothorax has been reported as an uncommon but severe complication in patients recovering from COVID-19 pneumonia. Even fewer cases of spontaneous bilateral tension pneumothorax have been reported as a result of infection. We present a patient with spontaneous bilateral tension pneumothorax 18 days after COVID-19 infection. The patient's symptoms began with a substernal tearing sensation and pain radiating to the back with dyspnea. Physical exam was significant for oxygen saturation of 75% on room air, tachycardia, and diminished breath sounds bilaterally. Imaging confirmed large bilateral pneumothoraces, and chest tubes were inserted emergently to restore lung volume. Pneumothorax is predominantly observed in those with severe infection but has been seen with mild symptoms as well. The development of pneumothorax is thought to result from diffuse lung injury that occurred from a cytokine storm during COVID infection. We speculate that our patient developed bulla as a result of infection, and the bulla spontaneously ruptured, inducing the bilateral collapse of the lungs. The mortality of such an event remains unknown, but without proper intervention, mortality increases significantly in these patients. As we continue to learn about the multitude of sequelae that can result from COVID-19 infection, pneumothorax should be considered in patients with a history of COVID pneumonia that presents with acute onset of dyspnea and chest pain. It is important to quickly recognize such cases as these patients have a narrow time frame for intervention, especially in the event of bilateral tension pneumothorax. Therefore, pneumothorax should be adequately assessed on initial examination, with the possibility of bilateral pneumothoraces in mind, to minimize morbidity and mortality.
同时性双侧自发性气胸是一种罕见的危及生命的疾病，可导致严重的呼吸窘迫、低氧血症和死亡。自发性气胸已被报道为新冠肺炎肺炎康复患者中一种不常见但严重的并发症。因感染导致的双侧自发性张力性气胸病例报告更少。我们报告一例新冠肺炎感染18天后出现双侧自发性张力性气胸的患者。患者症状始于胸骨后撕裂感，疼痛放射至背部并伴有呼吸困难。体格检查发现患者在室内空气中氧饱和度为75%、心动过速，双侧呼吸音减弱。影像学检查证实双侧大量气胸，紧急插入胸管以恢复肺容积。气胸主要见于重症感染患者，但也可见于症状较轻者。气胸的发生被认为是由于新冠感染期间细胞因子风暴导致的弥漫性肺损伤所致。我们推测我们的患者因感染形成了肺大疱，肺大疱自发破裂，导致双侧肺萎陷。此类事件的死亡率尚不清楚，但如果不进行适当干预，这些患者的死亡率会显著增加。随着我们继续了解新冠感染可能导致的众多后遗症，对于有新冠肺炎病史且出现急性呼吸困难和胸痛的患者，应考虑气胸的可能。快速识别此类病例很重要，因为这些患者的干预时间窗很窄，尤其是在双侧张力性气胸的情况下。因此，在初次检查时应充分评估气胸情况，考虑到双侧气胸的可能性，以尽量降低发病率和死亡率。
