1 - Department of Pediatric Infectious Diseases, Hospital Dona Estefânia, CHULC
2 - Department of Pediatric Surgery, Hospital Dona Estefânia, CHULC
- Congresso Internacional: 13th Excellence in Pediatrics Conference, em Amesterdão Holanda, apresentado sob a forma de Poster interativo.
Resumo: Introduction: Most children infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have mild symptoms. Acute respiratory distress syndrome (ARDS) and pneumonia are the most serious respiratory manifestations. Pneumothorax has been noted to complicate cases of COVID-19, but the exact incidence is still unknown. Case 1: A 16-year-old boy, previously healthy, diagnosed with COVID-19 was brought to the emergency department (ED) complaining of sudden onset right-sided chest pain and dry cough, without shortness of breath or fever. At physical examination he had significantly diminished breath sounds on the right side, without crackles or wheezes. A chest X-ray showed a massive right pneumothorax with a contralateral shift of the mediastinum. Two right subpleural blebs were found in the CT-scan. Conservative management with chest tube drainage and oxygen therapy was performed. The chest tube was removed on day five of admission, subsequent radiograph showed lung re-expansion. Two weeks later the patient returned with new sudden chest pain, was admitted and submitted to surgery with resection of the apex of the right lung and apical pleurectomy due to recurrency of the pneumothorax. Case 2: An obese 15-months boy was admitted with cough, rhinorrhea, shortness of breath, hypoxemia and oral intolerance. Inspiratory crackles, wheezes and increased expiratory time were found on physical examination. RT-PCR SARS-CoV-2 was positive. The CT revealed a pneumonia with right atelectasis, bilateral pneumothorax and right pneumomediastinum. Blood test revealed leukocytosis, neutrophilia and increased CRP (C-reactive protein). No surgical intervention was needed, conservative treatment with remdesivir and beta-adrenergic antagonists were performed during 5 days as well as oxygen therapy for 6 days, with clinical improvement and resolution of the radiologic findings.
Discussion: Spontaneous pneumothorax is a rare complication of COVID-19 in the absence of mechanical ventilation. In these cases, the patients didn’t have any preexisting pulmonary conditions; it seems structural lung injury caused pneumothorax following COVID-19 infection. The first case, also demonstrates that patients with COVID-19 can develop a significant pulmonary complication, despite only minimal lower respiratory tract symptoms. Clinicians should be vigilant about the diagnosis and treatment of this complication, as well as the follow-up.
Palavras chave: COVID19, pneumothorax