Pneumothorax with bullous lesions as a late complication of COVID-19 pneumonia - a report on two clinical cases

Schiller, Martin; Wunsch, Andreas; Fisahn, Juergen; Gschwendtner, Andreas; Huebner, Ute; Kick, Wolfgang

Background: Coronavirus-19 disease (COVID-19) is mainly affecting the respiratory tract, causing viral pneumonia with fever, hypoxemia, and cough. Commonly observed complications include acute respiratory failure, liver or kidney injury, and cardiovascular or neurologic symptoms. In some patients, inflammatory damage results in long term complications like pulmonary fibrosis, chronic pulmonary thrombotic microangiopathy, or neurologic symptoms. The developement of spontaneous pneumothorax is reported as a rare complication mainly in consequence to mechanic ventilation in the criticall ill. Case Report: We report on two cases of COVID-19 pneumonia complicated by a spontaneous pneumothorax and bullous lesions of the lung. Bilateral giant bullae were observed in one of the cases. This complication occurred after an initial resolvement of respiratory symptoms (day 16 and day 29 after COVID-19 treatment was started). Initially, both patients had shown a rather mild course of COVID-19 pneumonia and no mechanical ventilatory support had been necessary. Why Should an Emergency Physician Be Aware of This? In both cases, COVID-19 caused alveolar damage and formation of thoracic bullae with consequent spontaneous pneumothorax as a serious complication. Emergency physicans must be aware of this complication even if the initial COVID-19 symptoms have resolved.