Pneumatocele in a COVID-19 patient treated with endobronchial valves – A case report

AS. Bugge*^a (Dr), A. Sundset^a (Dr), TM. Aaløkken^a (Dr), LH. Jørgensen^a (Dr)

^a Oslo Univeristy Hospital, Oslo, NORWAY

* sbbuga@ous-hf.no

Background

In the course of COVID-19 pneumonia, spontaneous pneumomediastinum, pneumothorax, and pneumatocele have been reported as rare complications. It is assumed that positive pressure ventilation is the most important contributing factor to the pneumatocele formation. Additionally, lung injury caused by pneumonia and inflammation may lead to destruction of lung parenchyma.

Case report

A Caucasian man in his 40's was admitted to his local hospital six days after the first unspecific symptoms of COVID-19. His general condition deteriorated and he was treated in the intensive care unit, but did at no point require mechanical ventilation. During his recovery, he experienced a cough bout, after which his dyspnea worsened. CT pulmonary angiogram showed a 10 x 18 cm and gradually expanding cavitary lesion with an air-fluid level and surrounding atelectasis of the right lower lobe. The patient was treated by occlusion of all bronchial segments of the right lower lobe with endobronchial valves (EBV) (Zephyr®, Pulmonx Inc.). The pneumatocele was subsequently completely evacuated with a CT-guided insertion of a pigtail drainage, which was removed after six hours. The patient’s condition improved rapidly, and he was discharged one week later. On control scheduled 4 weeks after valve insertion, no pneumatocele could be identified on CT, and the valves were removed during flexible bronchoscopy. The lung function almost normalized and the patient returned to work 6 months after treatment.

Conclusion

Most pneumatoceles do not require specific treatment and disappear spontaneously. In this case, the large volume of a gradually expanding pneumatocele caused significant reduction in lung function and a clinical deterioration. Insertion of EBV in the affected lobe and subsequent decompression by CT-guided drainage was efficient, and clinical improvement was rapid as the pneumatocele disappeared. The EBV were removed 4 weeks later, and the lung function almost normalized.

Disclosure of funding source(s): none