POSTERIOR PNEUMOTHORAX IN A PATIENT WITH COVID-19 ON ECMO: A CASE REPORT

Abstract

TYPE: Case Report TOPIC: Chest Infections INTRODUCTION: Pneumothoraces are a known complication of SARS-CoV-2, but the reported rate varies between studies. Posterior pneumothoraces are extremely uncommon with few published case reports. CASE PRESENTATION: A 51-year-old woman presented with dyspnea, fever, pulmonary infiltrates, and positive SARS-CoV2 nasopharyngeal PCR. Her respiratory status deteriorated, she was intubated, and she ultimately required VV-ECMO cannulation. Her hospital course was complicated by DVT, pulmonary aspergillosis, E coli pneumonia, and left sided hydropneumothorax treated with chest tube drainage. On hospital day 56, the patient abruptly developed a vasopressor requirement with a rapid elevation in lactate. CXR identified a large left air space. POCUS of the chest was remarkable for A-line artifact and absent lung sliding of the left posterior chest. CT confirmed a posterior pneumothorax. A 14Fr small-bore chest tube was placed by IR with improvement in the size of the pneumothorax and hemodynamic status, shown on image C below. The patient’s course was further complicated by right-sided hydropneumothorax due to E. coli and E. faecalis empyema that was treated with 14Fr chest tube drainage. She gradually improved, was decannulated from VV-ECMO, and on hospital day 107 was discharged to an acute rehabilitation facility with all chest tubes removed. DISCUSSION: Here we describe a patient’s hospital course complicated by repeated pneumothoraces including a left posterior loculated pneumothorax causing tension physiology. CONCLUSIONS: Available literature suggests pneumothorax may occur in 11% of COVID-19 patients treated with ECMO. The proper management of these patients is still unclear and clinicians must take these complications into account when directing care. DISCLOSURE: Nothing to declare. KEYWORD: Pneumothorax