Post-COVID pneumatocele, a rare entity managed surgically: a case series

Abstract

Introduction: A pulmonary pneumatocele is a thin air filled cavitatory lesion that develops within the lung parenchyma. It is a unique, rarely occurring complication of COVID-19 pneumonia, most commonly detected by chest radiographs and computed tomography scans. Case presentation: The authors present a case series of four separate cases, all of which had suffered from COVID pneumonia, and now developed symptomatic pneumatocele. Two patients out of the four had also developed pneumothorax for which a tube thoracostomy was done, which is an infrequent complication of pneumatocele. One had an accompanying fungal infected loculated effusion. In all of these patients surgical management was approached as a treatment modality with three patients requiring bullectomy and one requiring lobectomy since image-guided drainage technique is not widely available in our resource-limited setting. Discussion: A pneumatocele, also called a pseudocyst, due to the absence of epithelial lining, is a thin-walled cystic cavity, filled with air that develops in the pulmonary interstitium. The most common cause is iatrogenic injury, due to prolonged mechanical ventilation. Pneumatoceles are usually asymptomatic and resolve spontaneously; however, image-guided drainage and surgical management can be opted for, in the presence of the complications. Conclusion: From our case report, it can be concluded that the surgical approach is relatively safe and effective, with increased survival benefits, especially in those patients who develop complicated pneumatocele.