Complications Of COVID-19 Pneumonia Research Articles

Remote variants of the disappearing lung syndrome as a complication of COVID-19 pneumonia

BACKGROUND. The pandemic of the coronavirus disease (COVID-19) associated with the SARS-CoV-2 virus has left many complications, including the pulmonary system. One of them is the syndrome of disappearing lungs. It occurred both in the acute period of the disease and in the post-COVID period (after 3-4 months) after inpatient treatment. Remote variants of the disappearing lung syndrome as a complication of COVID-19 pneumonia have not been studied to date.
 OBJECTIVE. To study distant variants of the course of the disappearing lung syndrome as one of the complications of nosocomial pneumonia of viral etiology (COVID-19) and to demonstrate it on clinical observations.
 MATERIALS AND METHODS. The dynamics of computed tomography (CT) data of patients with a complicated course of nosocomial viral pneumonia (COVID-19), who were treated at the SI “National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky of the NAMS of Ukraine”.
 RESULTS. Remote variants of the course of the disappearing lung syndrome as a complication of COVID-19 pneumonia are the development of bullous or diffuse emphysema of the lungs, giant thin-walled cyst-like cavities, and recurrent pneumothorax and pneumomediastinum. These variants are very diverse, and their results can be different even with identical radiological manifestations.
 CONCLUSIONS. The most unfavorable variant of the course of the disappearing lung syndrome is the development of recurrent pneumothorax and pneumomediastinum, which requires observation for more than 1.5-2 years and control CT scans of the chest.

PNEUMOMEDIASTINUM AS A COMPLICATION OF COVID-19 PNEUMONIA: CASE SERIES

Background: Pneumomediastinum (PM) is a rare pathological entity that is divided into two categories: secondary - with a known etiological factor, and spontaneous - with no clear etiology. This publication aims to highlight the two categories of PM as a complication of COVID-19 pneumonia. Case series: Six patients with PM as a complication of COVID-19 pneumonia were included in this study. Conventional chest X-rays and chest computed tomography were used to determine PM. In two of our patients, PM was a late consequence of COVID- 19 pneumonia. In two others, PM was established during conservative treatment of COVID-19 pneumonia. And for the last two cases, PM was diagnosed after tracheal intubation and mechanical ventilation while treating acute respiratory distress syndrome (ARDS). Concomitant spontaneous pneumothorax was found in four of our patients, leading to the invasive management of PM – drainage of the mediastinum by chest tube insertion. Conservative treatment of PM was the method of choice for the other two cases. Death was established in four cases – a rate of 75 %. Conclusion: With this case series, we highlight PM in its two forms - primary and secondary, as a serious complication of COVID-19 pneumonia. Our study highlights the importance of being aware of PM in COVID-19 pneumonia, even in patients managed without mechanical ventilation.

SARS-COV2 Pneumonia Revealed by Extensive Subcutaneous Emphysema

Spontaneous subcutaneous emphysema (SCE), pneumomediastinum, and pneumothorax in nonventilated COVID-19 patients are being increasingly recognized as complications of COVID-19 pneumonia. We report a case of a young man with no predisposing risk factors for pneumothorax who was diagnosed with a severe acute respiratory syndrome-COV2 pneumonitis revealed by extensive SCE with fatal outcome. Computed tomography of the thorax, abdomen, and pelvis revealed a diffuse lung injury, a pneumothorax, and pneumomediastinum. These complications of COVID-19 pneumonia may be associated with poor prognosis.

Spontaneous bilateral pneumothorax and pneumomediastinum independent of mechanical ventilation as complications of COVID-19 pneumonia: A case report.

Since the beginning of the COVID-19 pandemic, several infected patients have suffered from unusual and severe complications. Among these rare complications, pneumothorax and pneumomediastinum have attracted clinical attention. Such complications might be challenging to diagnose immediately because of the atypical presentation in some cases. Accurate diagnosis is essential to ensure effective treatment. Here, we present the case of a 62-year-old male who presented with symptoms of COVID-19 acute respiratory distress. There was diffuse subcutaneous emphysema in the face, neck, shoulder, and chest wall on clinical examination. The patient was started on oxygenation via a non-rebreather mask. On further evaluation, his chest X-ray revealed bilateral peripheral opacities in the lung fields, bilateral pneumothorax, and subcutaneous emphysema, after which intercostal drainage tubes were inserted. The patient's oxygen saturation was not satisfactory, and he was switched to a high-flow nasal cannula. However, his condition deteriorated, and he was put on mechanical ventilation and inotropic support. Despite our best efforts, the patient succumbed to the disease. We want to emphasize the importance of this adverse event despite his nonsmoking history and the exclusion of positive pressure ventilation. Although benign, early diagnosis of this condition is vital, as the condition could lead to worse morbidity if left unrecognized.

Superior Mesenteric Artery Thrombosis as a Complication of COVID-19 Pneumonia: A Case Report

Superior Mesenteric Artery Thrombosis as a Complication of COVID-19 Pneumonia: A Case Report

Air Leak Syndrome and Coronavirus Disease 2019 (Covid-19) Pneumonia – A Case Series

Background: The COVID 19 pandemic caused by Severe Acute Respiratory Syndrome Corona Virus – 2 has affected millions around the globe. It presents with a multisystem involvement, predominantly affecting the respiratory system. Spontaneous Air leak syndrome which includes subcutaneous emphysema, pneumomediastinum and pneumothorax has been reported as one of the complications of COVID-19 pneumonia. Method: This is a series of 10 cases, which presented with one or more manifestations of air leak syndrome among patients with covid 19 positive admitted in intensive care unit of Meenakshi Mission Hospital and Research Center, Madurai, India. Results: Out of the 365 cases analysed, 10 cases developed either subcutaneous emphysema, pneumomediastinum or pneumothorax. The incidence rate was 2.73% per 1000 population. None of the 10 patients was on invasive mechanical ventilation before developing air leak syndrome. No one had undergone an invasive procedure like central venous cannulation, intubation or bronchoscopy prior to the onset of air leak. Age group of the sample was 38 to 68 years. All the cases had elevated D-Dimer values. Conclusion: present case series shows that air leak syndrome can develop in COVID-19 patients receiving oxygenation through Nin-Invasive Ventilation (NIV) and High flow Nasal Cannula (HFNC). Recommendation: Patients with covid 19 who develop subcutaneous emphysema and pneumomediastinum should be carefully monitored for signs of pneumothorax which can be life threatening in a sick patient with borderline oxygenation. Keywords: COVID-19 pneumonia, subcutaneous emphysema, pneumomediastinum, pneumothorax

PNEUMOTHORAX, PNEUMOMEDIASTINUM, AND SUBCUTANEOUS EMPHYSEMA IN COVID-19 ARDS: OUR EXPERIENCE

TYPE: Abstract TOPIC: Critical Care PURPOSE: Many articles reports pneumothorax with or without pneumomedistinum complicate respiratory failure due Covid-19. Severe strain during persistent cough in COVID-19 pneumonia can be the causative factor for pneumothorax and maybe also for pneumomediastinum and subcutaneous emphysema METHODS: Cases were collected retrospectively from one hospital with inclusion criteria limited to a diagnosis of COVID-19 Acute Respiratory Distress Syndrome (ARDS) and the presence of either pneumothorax or pneumomediastinum. 387 patients were admitted in our ICU between March 2020 and July 2021. RESULTS: Of 387 patients with Covid-19 ARDS, 31 patient (8%) developed either pneumothorax or pneumomediastinum. 26 were male and 5 were female. 4 patients developed isolated pneumothorax. 11 developed pneumothorax+pneumomedistinum. 15 developed pneumomedistinum+subcutaneous emphysema and 1 patient developed pneumomediastinum+pneumoperitoneum. 23 patients were in Helmet CPAP at the onset of symptoms after a median of 5 days of ventilation while 8 patients were under invasive ventilation. Only 4 patient with pneumothorax needed chest tube. 22 patients needed tracheal intubation and mechanical ventilation for worsening of respiratory exchanges. 10 patients with pneumothorax and 10 patients with pneumomedistinum died during hospitalization in ICU both from septic shock CONCLUSIONS: These cases suggest that pneumothorax/pneumomedistinum are complications of Covid-19 pneumonia. All patients received respiratory support at the onset of pneumothorax/pneumomedistinum to suggest that barotrauma is one of the cause of that complications, anyway we cannot rule out pneumonia as a facilitating factor. Surely we need more studies to understand the pathophysiology of alveolar damage in Covid-19 pneumonia. CLINICAL IMPLICATIONS: Our experience suggest to be careful about respiratory support used and identify these complications early DISCLOSURE: Nothing to declare. KEYWORD: pneumothorax covid-19

Thoracic surgery in patients on veno-venous extracorporeal membrane oxygenation for COVID-19 associated acute respiratory distress syndrome.

Objectives:The COVID-19 pandemic has generated a new type of acute respiratory distress syndrome (ARDS) arising as a complication of COVID-19 pneumonia. Extreme cases require the support of extracorporeal membrane oxygenation (ECMO). Here we present the outcomes of patients that underwent surgical tracheostomy or thoracic surgery at a single tertiary centre whilst on ECMO support for COVID-19 related ARDS.Methods:18 patients requiring thoracic input whilst on ECMO support during the first wave of COVID-19 (March–June 2020) were included. Thoracic surgery was required both for performing surgical tracheostomies in the operating theatre and for treating emergencies arising under the ECMO treatment such as bleeding complications.Results:Thirteen patients underwent a surgical tracheostomy, whilst five patients had an invasive thoracic procedure. Anticoagulation was withheld for at least 12 h in the perioperative setting regardless of the indication. One patient was re-operated for haemothorax immediately after the end of the primary operation. 94.5% of the patients were successfully decannulated from ECMO support. Overall 30-day mortality in the cohort was 5.5% (1/18).Conclusions:Thoracic surgeons can play a valuable role in supporting an ECMO unit during the COVID pandemic, by treating ECMO related complications and by safely performing surgical tracheostomies. Withholding anticoagulation in the perioperative window was not associated with increased thromboembolic events and is desirable when interventions or surgery is indicated in this patient cohort to avoid excessive bleeding.

Evaluation of neurological disorders that develop concurrently with COVID-19 pneumonia: a retrospective analysis.

During the pandemic, many neurological symptoms have been evaluated as complications of COVID-19 pneumonia. To investigate the frequency and characteristics of neurological findings, and their effects on the prognosis of patients with COVID-19 pneumonia who consulted with the Neurology department. Data on 2329 patients who were hospitalized with the diagnosis of COVID-19 pneumonia in our hospital were scanned. The clinical, laboratory and radiological findings relating to treatment of 154 patients who required neurological consultation were retrospectively evaluated by reviewing the clinical notes. The number of COVID-19 pneumonia patients who required neurological consultations while hospitalized in the ICU was 94 (61.0%). The most common symptom among these patients was hyperactive delirium. Mean age, ferritin levels and CRP values ​​of those with delirium were higher, while the mean lymphocyte percentage were lower, than those of the patients without delirium. Epileptic seizures were observed in eight patients without an epilepsy diagnosis. Two patients were diagnosed with GBS and one patient with ICU neuropathy. The D-dimer levels of patients with acute hemorrhagic CVD and the thrombocyte levels of patients with acute ischemic CVD were found to be higher than in patients without acute ischemic CVD. The proportion of patients who required neurological consultations was higher in the ICUs. We observed neurological symptoms more frequently in the advanced age group. There were no significant increases in the incidence of other neurological conditions except delirium, in COVID-19 patients. We think that further studies are needed to support our data.

Three Month Follow-Up of Patients With COVID-19 Pneumonia Complicated by Pulmonary Embolism.

Background: Previous studies have demonstrated persistent dyspnoea and impairment of respiratory function in the follow-up of patients who have recovered from COVID-19 pneumonia. However, no studies have evaluated the clinical and functional consequences of COVID-19 pneumonia complicated by pulmonary embolism. Objective: The aim of our study was to assess the pulmonary function and exercise capacity in COVID-19 patients 3 months after recovery from pneumonia, either complicated or not by pulmonary embolism. Methods: This was a retrospective, single-centre, observational study involving 68 adult COVID-19 patients with a positive/negative clinical history of pulmonary embolism (PE) as a complication of COVID-19 pneumonia. Three months after recovery all patients underwent spirometry, diffusion capacity of the lungs for carbon monoxide (DLCO), and 6 minute walk test (6MWT). In addition, high-resolution computed tomography (HRCT) of the lung was carried out and CT-pulmonary angiography was conducted only in the PE+ subgroup. Patients with a previous diagnosis of PE or chronic lung diseases were excluded from the study. Results: Of the 68 patients included in the study, 24 had previous PE (PE+) and 44 did not (PE−). In comparison with the PE− subgroup, PE+ patients displayed a FVC% predicted significantly lower (87.71 ± 15.40 vs 98.7 ± 16.7, p = 0.009) and a significantly lower DLCO% predicted (p = 0.023). In addition, a higher percentage of patients were dyspnoeic on exercise, as documented by a mMRC score ≥1 (75% vs 54.3%, p < 0.001) and displayed a SpO2 <90% during 6MWT (37.5% vs 0%, p < 0.001). HRCT features suggestive of COVID-19 pneumonia resolution phase were present in both PE+ and PE− subjects without any significant difference (p = 0.24) and abnormalities at CT pulmonary angiography were detected in 57% of the PE+ subgroup. Conclusion: At the 3 month follow-up, the patients who recovered from COVID-19 pneumonia complicated by PE showed more dyspnoea and higher impairment of pulmonary function tests compared with those without PE.

SARS-COV2 pneumonia revealed by extensive subcutaneous emphysema

Spontaneous subcutaneous emphysema (SCE), pneumomediastinum, and pneumothorax in nonventilated COVID-19 patients are being increasingly recognized as complications of COVID-19 pneumonia. We report a case of a young man with no predisposing risk factors for pneumothorax who was diagnosed with a severe acute respiratory syndrome-COV2 pneumonitis revealed by extensive SCE with fatal outcome. Computed tomography of the thorax, abdomen, and pelvis revealed a diffuse lung injury, a pneumothorax, and pneumomediastinum. These complications of COVID-19 pneumonia may be associated with poor prognosis.

Pulmonary fibrosis as an outcome of COVID-19 pneumonia

In this study, we report three cases of persistent severe respiratory failure and radiological signs of diffuse pulmonary fibrosis in patients after COVID-19 related pneumonia. Chest CT criteria for a diagnosis of pulmonary fibrosis include the presence of traction bronchiectasis and parenchymal bands (linear opacities), as well as numerous small subpleural cystic air spaces (honeycombing). The study found that all cases of fibrosis were associated with such risk factors as male gender, old age, and multicomorbidity. Chest CT of one patient with acute respiratory distress syndrome showed radiographic characteristics of pulmonary fibrosis together with the presence of ground glass opacities (GGO) – the main CT feature of COVID-19 pneumonia. In two other patients, CT features of pulmonary fibrosis appeared in about 2 months after the hospital stay.Thus, pulmonary fibrosis is severe and rapidly progressive complication of COVID-19 pneumonia with a poor prognosis, especially in patients with multiple risk factors.

COVID‐19‐associated subacute invasive pulmonary aspergillosis

BackgroundThough invasive pulmonary aspergillosis is a well known complication of COVID‐19 pneumonia, indolent forms of aspergillosis have been rarely described.MethodsWe prospectively collected the clinico‐radio‐microbiological data of 10 patients of subacute invasive pulmonary aspergillosis (SAIA), who presented to our hospital with recent history of COVID‐19 pneumonia along with cavitary lung disease, positive IgG (against Aspergillus) with or without positive respiratory samples for Aspergillus spp.ResultThe mean age of presentation of SAIA was 50.7 ± 11.8 years. All the patients had recently recovered from severe COVID‐19 illness with a mean duration of 29.2 ± 12 days from COVID‐19 positivity. Cough was the predominant symptom seen in 8/10 (80%) patients followed by haemoptysis. 7/10 (70%) patients were known diabetic. While serum galactomannan was positive in 5/9 patients (55.5%), fungal culture was positive in 2/7 patients (28.5%) and polymerase chain reaction (PCR) for Aspergillus was positive in three patients. Eight (80%) patients presented with a single cavitary lesion; pseudoaneurysm of pulmonary artery was seen in two patients and post‐COVID‐19 changes were seen in all patients. All patients were treated with voriconazole, out of which four (40%) patients died during the follow‐up period.ConclusionSAIA should be considered in the differential diagnosis of cavitating lung lesions in patients with recent history of COVID‐19 in the background of steroid use with or without pre‐existing diabetes.

Thrombosis of the pulmonary arteries branches as a complication of COVID-19 pneumonia (a case report)

The article presents a rare case of thrombosis of the pulmonary arteries branches, which developed in a patient two months after infection with the SARS-CoV-2 virus, that caused bilateral polysegmental pneumonia. The thrombosis was suspected because of a high plasma D-dimer level. Contrast-enhanced chest CT was performed to make a definitive diagnosis. The absence of blood clots in the veins of the lower extremities and pelvis allowed us to conclude that the patient did not have thromboembolism, but rather a pulmonary thrombosis in situ. Such possible causes of venousthromboembolic complications as tumors, systemic diseases of the connective tissue, and antiphospholipid syndrome were excluded based on negative tests for tumor and autoimmune diseases markers. The long-stay in the hospital was associated with the inability of the patient to maintain the normal level of blood oxygen saturation independently due to the large area of the lung damage associated with COVID-19 pneumonia and ischemia caused by thrombosis of the branches of the pulmonary arteries.

A Pictorial Review of the Role of Imaging in the Detection, Management, Histopathological Correlations, and Complications of COVID-19 Pneumonia.

Imaging plays an important role in the detection of coronavirus (COVID-19) pneumonia in both managing the disease and evaluating the complications. Imaging with chest computed tomography (CT) can also have a potential predictive and prognostic role in COVID-19 patient outcomes. The aim of this pictorial review is to describe the role of imaging with chest X-ray (CXR), lung ultrasound (LUS), and CT in the diagnosis and management of COVID-19 pneumonia, the current indications, the scores proposed for each modality, the advantages/limitations of each modality and their role in detecting complications, and the histopathological correlations.

Spontaneous pneumomediastinum, pneumopericardium, pneumothorax and subcutaneous emphysema in patients with COVID-19 pneumonia, a case report

BackgroundSpontaneous pneumomediastinum unrelated to mechanical ventilation is a newly described complication of COVID-19 pneumonia. The objective of this case presentation is to highlight an important complication and to explore potential predisposing risk factors and possible underlying pathophysiology of this phenomenon.Case presentationWe present two patients with COVID-19 pneumonia complicated by spontaneous pneumomediastinum, pneumopericardium, pneumothorax and subcutaneous emphysema without positive pressure ventilation. Both patients had multiple comorbidities, received a combination of antibiotics, steroids and supportive oxygen therapy, and underwent routine laboratory workup. Both patients then developed spontaneous pneumomediastinum and ultimately required intubation and mechanical ventilation, which proved to be challenging to manage.ConclusionsSpontaneous pneumomediastinum is a serious complication of COVID-19 pneumonia, of which clinicians should be aware. Further studies are needed to determine risk factors and laboratory data predictive of development of spontaneous pneumomediastinum in COVID-19 pneumonia.

Radiological manifestations of pulmonary diseases in COVID-19

Klinisches/methodisches ProblemSeit dem Auftreten des neuartigen Coronavirus Ende 2019 und der damit verbundenen Erkrankung – Coronavirus Disease 2019 (COVID-19) – kam es zum Ausrufen einer Pandemie durch die Weltgesundheitsorganisation (WHO). Der Referenzstandard für die Diagnose ist der Virusnachweis mittels „reverse transcription polymerase chain reaction“ (RT-PCR). Bei hoher Spezifizität ist die Sensitivität der RT-PCR jedoch stark abhängig von der Symptomdauer, der Viruslast, der Qualität der Probe sowie des verwendeten Tests.Radiologische StandardverfahrenIm Rahmen von COVID-19 werden primär Thoraxröntgen und Thorax-Computertomographie(CT) zur Erkennung von Lungenmanifestationen bzw. deren Ausdehnung und von Komplikationen eingesetzt.LeistungsfähigkeitDie Sensitivität und Spezifizität des Thoraxröntgens bei COVID-19 ist gering. Die Thorax-CT weist eine hohe Sensitivität von ungefähr 90 % bei jedoch geringer Spezifizität auf (zwischen 25 und 33 %).Empfehlung für die PraxisDie Indikation für die Durchführung von Bildgebung im Rahmen von COVID-19 sollte immer mit Bedacht gestellt werden, um das Übertragungsrisiko für medizinisches Personal und andere Patienten zu minimieren. Die Bildgebung ist vor allem hilfreich zur Evaluierung des Ausmaßes der Lungenbeteiligung der Erkrankung, zur Abgrenzung von Komplikationen und Differenzialdiagnosen. Typischerweise zeigen sich bilaterale, subpleurale Milchglasverdichtungen mit oder ohne Konsolidierungsareale. Im Verlauf können auch Veränderungen einer organisierenden Pneumonie beobachtet werden. Bei Untersuchungen nach Genesung einer COVID-19-Pneumonie ist auf fibrotische Lungenveränderungen zu achten.