Monaldi Archives for Chest Disease (Sep 2021)

Full medical treatment of COVID-19 associated large pneumothorax - A case report

  • Alberto Fantin,
  • Nadia Castaldo,
  • Paolo Vailati,
  • Giuseppe Morana,
  • Vincenzo Patruno

DOI
https://doi.org/10.4081/monaldi.2021.1956

Abstract

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A 52-year-old man was re-admitted two weeks after recovering from severe COVD-19 following a 3-days history of cough and worsening shortness of breath. The chest radiograph showed a large right-sided pneumothorax. The first attempt at drainage, performed through a large bored tube, failed. Due to the large dimension of the pneumothorax, and the lung condition (extensive consolidation and diffuse bullous dystrophies), the only thoracic surgical approach prospected was a pneumonectomy. Willing to preserve the lung, the pulmonology team attempted a multi-phase medical-oriented strategy based on medical thoracoscopy. Therefore, the patient underwent 5 chest tube insertions, 2 talc pleurodesis, and an intrapleural blood patch. Air leakage resolution was progressively achieved, and the patient became asymptomatic. We strongly encourage a medical thoracoscopic approach for the patient presenting with recurrent pneumothorax in order to ensure complete lung re-expansion and preserve lung parenchyma.

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