Air Spaces in Patients Diagnosed with COVID-19 Pneumonitis- A Rare Complication

Author(s): Zimna K, Sobiecka M, Lewandowska K, Wyrostkiewicz D, Szturmowicz M, Lyzwa E, Blasinska K, Jakubowska L, Roszkowski Sliz K, Tomkowski W.

Introduction: The outbreak of coronavirus disease 2019 (COVID-19) with its overwhelming morbidity and mortality has created a significant challenge for health systems worldwide. Although peripheral ground-glass opacities are the most frequent radiologic feature of COVID-19 described in the literature, late rare complications such as cavitations, pneumatocele, lung cyst, pneumothorax, empyema or hemothorax are occasionally reported.

Methods: We performed a retrospective study and described a group of eight patients, diagnosed with COVID-19, confirmed by the RT-PCR for SARS-CoV-2 and complicated with cystic air spaces. We have searched for studies describing air spaces in subjects with COVID-19 and analyzed the probable pathophysiology of air spaces development.

Results: Among 29 patients diagnosed with COVID-19 pneumonia complicated by air spaces, 19 (65,5%) received surgical intervention. Of note, 25 (86%) were males. Of the 19 interventions, 6 (20,6%) were exclusively chest drain insertions and the rest 13 (45%) required more advanced procedures like VATS or thoracotomy. Most patients did not have any risk factor for such a complication. Among the group- 18 (62%) had no history of smoking, 16 (55%) had no history of previous diseases and only 1 (3%) had the history of COPD. More than half of the patients (18- 62%) did not require mechanical ventilation during initial viral pneumonitis.

Conclusion: According to our observation and reviewed literature, not every pneumatocele or lung cyst requires surgical intervention the decision should be taken on the individual basis. Reasons for surgical intervention included non-resolving pneumothorax, superinfection of pneumatocele, non-responding to antibiotic therapy and hemothorax.