Department of Infectious Disease, Beijing Tongren Hospital, Capital Medical University, No. 1, DongJiaoMinXiang, DongCheng District, Beijing, China.
Department of Respiratory and Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, No. 1, DongJiaoMinXiang, DongCheng District, Beijing, China.
BMC Pulm Med. 2024 Jul 19;24(1):351. doi: 10.1186/s12890-024-03169-5.
While spontaneous pneumothorax has been documented in COVID-19 patients, reports on recurrent spontaneous pneumothorax due to cystic lesions in convalescent COVID-19 patients are scarce. The progression of these lung cystic lesions remains inadequately explored.
An 81-year-old male, a non-smoker with a history of rheumatoid arthritis, presented with fever, cough, and expectoration for 14 days. Initially diagnosed with moderate COVID-19, he deteriorated to severe COVID-19 despite adherence to local treatment guidelines. Successive identification of three cystic lesions termed "bulla" or "pneumatocele", and one cystic lesion with air-fluid level, referred to as "pneumo-hamatocele" (PHC), occurred in his lungs. Gradual improvement followed anti-inflammatory therapy and optimal supportive care. However, on day 42, sudden worsening dyspnea prompted a computed tomography (CT) scan, confirming a right spontaneous pneumothorax and subcutaneous emphysema, likely due to PHC rupture. Discharge followed chest tube implementation for pneumothorax resolution. On day 116, he returned to the hospital with mild exertional dyspnea. Chest CT revealed recurrent right pneumothorax from a remaining cyst in the right lung. Apart from our patient, literature retrieval identified 22 COVID-19 patients with spontaneous pneumothorax due to cystic lesions, with a male predominance (95.6%; 22/23). Diagnosis of pneumothorax and lung cystic lesions occurred around day 29.5 (range: 18-35) and day 26.4 (± 9.8) since symptom onset, respectively. Except for one patient whose pneumothorax occurred on day seven of illness, all patients eventually recovered.
Recurrent spontaneous pneumothorax secondary to lung cystic lesions may manifest in convalescent COVID-19 patients, particularly males with COVID-19 pneumonia. Chest CT around 2 to 3 weeks post-symptom onset may be prudent to detect cystic lesion development and anticipate spontaneous pneumothorax.
虽然 COVID-19 患者已被记录有自发性气胸，但关于康复期 COVID-19 患者因囊性病变导致复发性自发性气胸的报道却很少。这些肺囊性病变的进展仍未得到充分探讨。
一名 81 岁男性，不吸烟，有类风湿关节炎病史，因发热、咳嗽和咳痰 14 天就诊。最初被诊断为中度 COVID-19，尽管遵循了当地的治疗指南，但病情恶化至重度 COVID-19。他的肺部相继出现三个囊性病变，分别称为“大疱”或“气肿疱”，以及一个囊性病变伴气液平面，称为“肺气囊肿”（PHC）。在抗炎治疗和最佳支持治疗后逐渐好转。然而，在第 42 天，突然恶化的呼吸困难促使进行了计算机断层扫描（CT）检查，证实右侧自发性气胸和皮下气肿，可能是由于 PHC 破裂所致。气胸缓解后拔除胸腔引流管。第 116 天，他因轻度活动后呼吸困难再次入院。胸部 CT 显示右侧肺内残留的囊肿引起复发性右侧气胸。除了我们的患者，文献检索还发现了 22 例因囊性病变导致自发性气胸的 COVID-19 患者，其中男性占 95.6%（22/23）。气胸和肺囊性病变的诊断分别发生在症状出现后第 29.5 天（范围：18-35 天）和第 26.4 天（±9.8 天）。除了一名患者在发病第 7 天发生气胸外，所有患者最终都康复了。
康复期 COVID-19 患者可能出现继发性复发性自发性气胸，尤其是 COVID-19 肺炎的男性患者。症状出现后 2 至 3 周进行胸部 CT 检查可能有助于发现囊性病变的发展，并预测自发性气胸的发生。
