Giant compressive emphysema: a rare complication of COVID-19

BMC Infectious Diseases

Mandimbisoa Noely Oberlin Andriamihary¹  Rivo Andry Rakotoarivelo²  Johary Andriamizaka Andriamamonjisoa³  Roger Dominique Randrianarimalala⁴  Solohery Jean Noël Ratsimbazafy⁴  Julien Rakotoson⁵  Stéphane Ralandison⁵ 

[1] Department of Cardiology, Faculty of Medicine of Antananarivo, Joseph Rasta Befelatanana University Hospital, 101, Antananarivo, Madagascar;Department of Infectious Diseases, Faculty of Medicine Andrainjato Fianarantsoa, University Hospital Tambohobe Fianarantsoa, 301, Fianarantsoa, Madagascar;Department of Infectious Diseases, Faculty of Medicine Antananarivo, Joseph Raseta Befelatanana University Hospital Antananarivo, 101, Antananarivo, Madagascar;Department of Internal Medicine, Faculty of Medicine Antananarivo, Military Hospital Soavinandriana Antananarivo, 101, Antananarivo, Madagascar;Department of Rheumatology, Faculty of Medicine Antananarivo, Morafeno University Hospital Toamasina, 501, Toamasina, Madagascar;

关键词: Emphysema;    Giant;    Coronavirus disease 2019;    CT scan;   

DOI  :  10.1186/s12879-021-07006-6

来源: Springer

【 摘 要 】

BackgroundThe severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a new ribonucleic acid (RNA) beta-coronavirus, responsible for a worldwide pandemic. Very few cases of SARS-COV-2-related emphysema have been described, except among patients with chronic obstructive pulmonary disease. The thoracic CT scan is the key examination for the diagnosis and allows to evaluate the severity of the pulmonary involvement. The prognosis of the patient with giant emphysema (GE) on coronavirus disease 2019 (COVID-19) in critical or severe form remains poor. We report an original case of COVID-19 pneumonia, critical form, complicated by a giant compressive left emphysema of 22.4 cm in a young subject without respiratory comorbidities.Case presentationA 34-year-old man was hospitalized for left laterothoracic pain. He had no prior medical history. The physical examination revealed tympany on percussion of the left lung. The CT scan confirmed COVID-19 pneumonia with 95% lung involvement. Also, the presence of a voluminous left sub pleural emphysema of 22.4 cm with compression of the ipsilateral pulmonary parenchyma as well as the mediastinal structures towards the right side. The diagnosis COVID-19 pneumonia, critical form, complicated by a compressive left giant emphysema was made. He was put on oxygen, a dual antibiotic therapy, a corticotherapy, and curative doses of enoxaparin. A thoracic drainage surgery was performed at 24th day of hospitalization, which confirmed the giant emphysema. The patient remains on long-term oxygen therapy.ConclusionThe COVID-19 has polymorphic manifestations, pneumonia is the most important one. There are relatively few reports associating COVID-19 and emphysema; furthermore, reports associating COVID-19 and giant emphysema are extremely scarce. CT scans can confirm the diagnosis and differentiate it from a pneumothorax. The pulmonary prognosis of the association of COVID-19 in its severe or critical form with giant emphysema remains poor.

【 授权许可】

CC BY