PDF herunterladen
Semin Respir Crit Care Med 2023; 44(04): 437-446
DOI: 10.1055/s-0043-1769616
Review Article

COVID-19-Related Pleural Diseases

Beenish Iqbal
1   Respiratory Trials Unit, Oxford Centre for Respiratory Disease, Oxford University Hospital, Oxford Centre for Respiratory Medicine, Churchill Hospital, NHS Trust, Oxford, United Kingdom
,
Najib M. Rahman
1   Respiratory Trials Unit, Oxford Centre for Respiratory Disease, Oxford University Hospital, Oxford Centre for Respiratory Medicine, Churchill Hospital, NHS Trust, Oxford, United Kingdom
2   Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
,
Rob J. Hallifax
1   Respiratory Trials Unit, Oxford Centre for Respiratory Disease, Oxford University Hospital, Oxford Centre for Respiratory Medicine, Churchill Hospital, NHS Trust, Oxford, United Kingdom
2   Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
› Institutsangaben
› Weitere Informationen
    Lizenzen und Reprints

Abstract

Coronavirus disease 2019 (COVID-19)-related pleural diseases are now well recognized. Since the beginning of the pandemic, increasing cases of pleural diseases including pneumothorax, pneumomediastinum, and pleural effusion with severe COVID-19 infection have attracted the attention of physicians and are not incidental or due to barotrauma. The complicated course of COVID-19 illness highlights the complex pathophysiological underpinnings of pleural complications. The management of patients with pneumothorax and pneumomediastinum is challenging as the majority require assisted ventilation; physicians therefore appear to have a low threshold to intervene. Conversely, pleural effusion cases, although sharing some similar patient characteristics with pneumothorax and pneumomediastinum, are in general managed more conservatively. The evidence suggests that patients with COVID-19-related pleural diseases, either due to air leak or effusion, have more severe disease with a worse prognosis. This implies that prompt recognition of these complications and targeted management are key to improve outcomes.

Keywords

COVID-19 - pleural diseases - pneumothorax - pneumomediastinum - pleural effusion - complications


Publikationsverlauf

Artikel online veröffentlicht:
10. Juli 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Hallifax RJ, Goldacre R, Landray MJ, Rahman NM, Goldacre MJ. Trends in the incidence and recurrence of inpatient-treated spontaneous pneumothorax, 1968-2016. JAMA 2018; 320 (14) 1471-1480
    CrossrefPubMedSuche in Google Scholar
  • 2 MacDuff A, Arnold A, Harvey J, Group BTSPDG. BTS Pleural Disease Guideline Group. Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010; 65 (Suppl. 02) ii18-ii31
    PubMedSuche in Google Scholar
  • 3 Onuki T, Ueda S, Yamaoka M. et al. Primary and secondary spontaneous pneumothorax: prevalence, clinical features, and in-hospital mortality. Can Respir J 2017; 2017: 6014967
    CrossrefPubMedSuche in Google Scholar
  • 4 Martinelli AW, Ingle T, Newman J. et al. COVID-19 and pneumothorax: a multicentre retrospective case series. Eur Respir J 2020; 56 (05) 2002697
    CrossrefPubMedSuche in Google Scholar
  • 5 Yang X, Yu Y, Xu J. et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020; 8 (05) 475-481
    CrossrefPubMedSuche in Google Scholar
  • 6 Marciniak SJ, Farrell J, Rostron A. et al. COVID-19 pneumothorax in the UK: a prospective observational study using the ISARIC WHO clinical characterisation protocol. Eur Respir J 2021; 58 (03) 2100929
    CrossrefPubMedSuche in Google Scholar
  • 7 El-Shabasy RM, Nayel MA, Taher MM, Abdelmonem R, Shoueir KR, Kenawy ER. Three waves changes, new variant strains, and vaccination effect against COVID-19 pandemic. Int J Biol Macromol 2022; 204: 161-168
    CrossrefPubMedSuche in Google Scholar
  • 8 Sihoe AD, Wong RH, Lee AT. et al. Severe acute respiratory syndrome complicated by spontaneous pneumothorax. Chest 2004; 125 (06) 2345-2351
    CrossrefPubMedSuche in Google Scholar
  • 9 Chopra A, Al-Tarbsheh AH, Shah NJ. et al. Pneumothorax in critically ill patients with COVID-19 infection: incidence, clinical characteristics and outcomes in a case control multicenter study. Respir Med 2021; 184: 106464
    CrossrefPubMedSuche in Google Scholar
  • 10 Miró Ò, Llorens P, Jiménez S. et al; Spanish Investigators on Emergency Situations Team (SIESTA) Network. Frequency, risk factors, clinical characteristics, and outcomes of spontaneous pneumothorax in patients with coronavirus disease 2019: a case-control, emergency medicine-based multicenter study. Chest 2021; 159 (03) 1241-1255
    CrossrefPubMedSuche in Google Scholar
  • 11 McGuinness G, Zhan C, Rosenberg N. et al. Increased incidence of barotrauma in patients with COVID-19 on invasive mechanical ventilation. Radiology 2020; 297 (02) E252-E262
    CrossrefPubMedSuche in Google Scholar
  • 12 Chen N, Zhou M, Dong X. et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395 (10223): 507-513
    CrossrefPubMedSuche in Google Scholar
  • 13 Zantah M, Dominguez Castillo E, Townsend R, Dikengil F, Criner GJ. Pneumothorax in COVID-19 disease- incidence and clinical characteristics. Respir Res 2020; 21 (01) 236
    CrossrefPubMedSuche in Google Scholar
  • 14 Kumar TPMK, Arjun AS, Monica N. Assessment of potential risk factors, characteristics, and outcome of pneumothorax and pneumomediastinum in patients with COVID-19: a retrospective case-control study. JCDR 2022; 16 (11) PC01-PC6
    PubMedSuche in Google Scholar
  • 15 Udwadia ZF, Toraskar KK, Pinto L. et al. Increased frequency of pneumothorax and pneumomediastinum in COVID-19 patients admitted in the ICU: a multicentre study from Mumbai, India. Clin Med (Lond) 2021; 21 (06) e615-e619
    CrossrefPubMedSuche in Google Scholar
  • 16 Kecskes G, Szabo A, Sutori D, Maroti P, Marovics G, Molnar TF. Pneumothorax/pneumomediastinum and pre-existing lung pathology in ventilated COVID-19 patients: a cohort study. J Thorac Dis 2022; 14 (12) 4733-4740
    CrossrefPubMedSuche in Google Scholar
  • 17 Ekanem E, Podder S, Donthi N. et al. Spontaneous pneumothorax: an emerging complication of COVID-19 pneumonia. Heart Lung 2021; 50 (03) 437-440
    CrossrefPubMedSuche in Google Scholar
  • 18 Ayazi S, Zebarjadi J, Grubic AD, Tahmasbi H, Ayazi K, Jobe BA. Pneumothorax as the presenting manifestation of COVID-19. J Thorac Dis 2020; 12 (12) 7488-7493
    CrossrefPubMedSuche in Google Scholar
  • 19 Das KM, Lee EY, Al Jawder SE. et al. Acute Middle East respiratory syndrome coronavirus: temporal lung changes observed on the chest radiographs of 55 patients. AJR Am J Roentgenol 2015; 205 (03) W267-74
    PubMedSuche in Google Scholar
  • 20 Kong W, Agarwal PP. Chest imaging appearance of COVID-19 infection. Radiol Cardiothorac Imaging 2020; 2 (01) e200028
    CrossrefPubMedSuche in Google Scholar
  • 21 do Lago VC, Cezare TJ, Fortaleza CMCB, Okoshi MP, Baldi BG, Tanni SE. Does COVID-19 increase the risk for spontaneous pneumothorax?. Am J Med Sci 2020; 360 (06) 735-737
    CrossrefPubMedSuche in Google Scholar
  • 22 Agrawal ASK, Satapathy G, Sethi HS, Sharawat A, Reddy DS. Spontaneous pneumomediastinum, pneumothorax and subcutaneous emphysema in COVID-19 patients-a case series. Egypt J Radiol Nucl Med 2021; 52 (01) 27
    CrossrefPubMedSuche in Google Scholar
  • 23 Sun R, Liu H, Wang X. Mediastinal emphysema, giant bulla, and pneumothorax developed during the course of COVID-19 pneumonia. Korean J Radiol 2020; 21 (05) 541-544
    CrossrefPubMedSuche in Google Scholar
  • 24 Liu K, Zeng Y, Xie P. et al. COVID-19 with cystic features on computed tomography: a case report. Medicine (Baltimore) 2020; 99 (18) e20175
    CrossrefPubMedSuche in Google Scholar
  • 25 Guven BB, Erturk T, Kompe Ö, Ersoy A. Serious complications in COVID-19 ARDS cases: pneumothorax, pneumomediastinum, subcutaneous emphysema and haemothorax. Epidemiol Infect 2021; 149: e137
    CrossrefPubMedSuche in Google Scholar
  • 26 Xu Z, Shi L, Wang Y. et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med 2020; 8 (04) 420-422
    Suche in Google Scholar
  • 27 Taha M, Elahi M, Wahby K, Samavati L. Incidence and risk factors of COVID-19 associated pneumothorax. PLoS One 2022; 17 (08) e0271964
    CrossrefPubMedSuche in Google Scholar
  • 28 Pacheco-Montoya D, Ortega-Rosales A, Malla-Gonzalez A, Jimenez-Sarango A. Spontaneous pneumothorax in COVID-19: report of three cases. Radiol Case Rep 2022; 17 (03) 1002-1007
    CrossrefPubMedSuche in Google Scholar
  • 29 Love J, Chenyek R, Osta A. Spontaneous pneumothorax as a late complication of mild COVID-19 infection: a case report. Cureus 2022; 14 (03) e23294
    PubMedSuche in Google Scholar
  • 30 Belletti A, Palumbo D, Zangrillo A. et al; COVID-BioB Study Group. Predictors of pneumothorax/pneumomediastinum in mechanically ventilated COVID-19 patients. J Cardiothorac Vasc Anesth 2021; 35 (12) 3642-3651
    CrossrefPubMedSuche in Google Scholar
  • 31 Inui S, Gonoi W, Kurokawa R. et al. The role of chest imaging in the diagnosis, management, and monitoring of coronavirus disease 2019 (COVID-19). Insights Imaging 2021; 12 (01) 155
    CrossrefPubMedSuche in Google Scholar
  • 32 Lê MP, Jozwiak M, Laghlam D. Current advances in lung ultrasound in COVID-19 critically ill patients: a narrative review. J Clin Med 2022; 11 (17) 5001
    CrossrefPubMedSuche in Google Scholar
  • 33 Nava GW, Walker SP. Management of the secondary spontaneous pneumothorax: current guidance, controversies, and recent advances. J Clin Med 2022; 11 (05) 1173
    CrossrefPubMedSuche in Google Scholar
  • 34 Shah S, Pokhrel A, Chamlagain R. et al. Case report of a spontaneous pneumothorax after the recovery from COVID-19 pneumonia: a delayed complication. Clin Case Rep 2021; 9 (10) e04971
    CrossrefPubMedSuche in Google Scholar
  • 35 Ozsoy IE, Tezcan MA, Guzeldag S, Ozdemir AT. Is spontaneous pneumomediastinum a poor prognostic factor in COVID-19?. J Coll Physicians Surg Pak 2021; 31 (02) 132-137
    CrossrefPubMedSuche in Google Scholar
  • 36 Melhorn J, Achaiah A, Conway FM. et al. Pneumomediastinum in COVID-19: a phenotype of severe COVID-19 pneumonitis? The results of the United Kingdom (POETIC) survey. Eur Respir J 2022; 60 (03) 2102522
    CrossrefPubMedSuche in Google Scholar
  • 37 Sahni S, Verma S, Grullon J, Esquire A, Patel P, Talwar A. Spontaneous pneumomediastinum: time for consensus. N Am J Med Sci 2013; 5 (08) 460-464
    CrossrefPubMedSuche in Google Scholar
  • 38 Kouritas VK, Papagiannopoulos K, Lazaridis G. et al. Pneumomediastinum. J Thorac Dis 2015; 7 (Suppl. 01) S44-S49
    CrossrefPubMedSuche in Google Scholar
  • 39 Caceres M, Ali SZ, Braud R, Weiman D, Garrett Jr HE. Spontaneous pneumomediastinum: a comparative study and review of the literature. Ann Thorac Surg 2008; 86 (03) 962-966
    CrossrefPubMedSuche in Google Scholar
  • 40 Grapatsas K, Tsilogianni Z, Leivaditis V. et al. Hamman's syndrome (spontaneous pneumomediastinum presenting as subcutaneous emphysema): a rare case of the emergency department and review of the literature. Respir Med Case Rep 2017; 23: 63-65
    PubMedSuche in Google Scholar
  • 41 Yang F, Shi S, Zhu J, Shi J, Dai K, Chen X. Analysis of 92 deceased patients with COVID-19. J Med Virol 2020; 92 (11) 2511-2515
    CrossrefPubMedSuche in Google Scholar
  • 42 Peiris JS, Chu CM, Cheng VC. et al; HKU/UCH SARS Study Group. Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Lancet 2003; 361 (9371): 1767-1772
    CrossrefPubMedSuche in Google Scholar
  • 43 Chu CM, Leung YY, Hui JY. et al. Spontaneous pneumomediastinum in patients with severe acute respiratory syndrome. Eur Respir J 2004; 23 (06) 802-804
    CrossrefPubMedSuche in Google Scholar
  • 44 Brito J, Gregório P, Mariani A. et al. Pneumomediastinum in COVID-19 disease: outcomes and relation to the Macklin effect. Asian Cardiovasc Thorac Ann 2021; 29 (06) 541-548
    CrossrefPubMedSuche in Google Scholar
  • 45 Wali A, Rizzo V, Bille A, Routledge T, Chambers AJ. Pneumomediastinum following intubation in COVID-19 patients: a case series. Anaesthesia 2020; 75 (08) 1076-1081
    CrossrefPubMedSuche in Google Scholar
  • 46 Peckham H, de Gruijter NM, Raine C. et al. Male sex identified by global COVID-19 meta-analysis as a risk factor for death and ITU admission. Nat Commun 2020; 11 (01) 6317
    CrossrefPubMedSuche in Google Scholar
  • 47 Manna S, Maron SZ, Cedillo MA. et al. Spontaneous subcutaneous emphysema and pneumomediastinum in non-intubated patients with COVID-19. Clin Imaging 2020; 67: 207-213
    CrossrefPubMedSuche in Google Scholar
  • 48 Macklin CC. Transport of air along sheaths of pulmonic blood vessels from alveoli to mediastinum. Arch Intern Med 1939; 64: 913-926
    CrossrefPubMedSuche in Google Scholar
  • 49 Macklin M, Macklin C. Malignant interstitial emphysema of the lungs and mediastinum as an important occult complication in many respiratory diseases and other conditions: an interpretation of the clinical literature in the light of laboratory experiment. Medicine (Baltimore) 1944; 23 (04) 281-358
    CrossrefPubMedSuche in Google Scholar
  • 50 Peiris JS, Lai ST, Poon LL. et al; SARS study group. Coronavirus as a possible cause of severe acute respiratory syndrome. Lancet 2003; 361 (9366): 1319-1325
    CrossrefPubMedSuche in Google Scholar
  • 51 López Vega JM, Parra Gordo ML, Diez Tascón A, Ossaba Vélez S. Pneumomediastinum and spontaneous pneumothorax as an extrapulmonary complication of COVID-19 disease. Emerg Radiol 2020; 27 (06) 727-730
    CrossrefPubMedSuche in Google Scholar
  • 52 Somasundram K, Agbontaen K, Singh S. Pneumomediastinum in COVID-19: merely a matter of lung frailty?. Respiration 2021; 100 (12) 1251-1255
    CrossrefPubMedSuche in Google Scholar
  • 53 Sethi SM, Ahmed AS, Hanif S, Aqeel M, Zubairi ABS. Subcutaneous emphysema and pneumomediastinum in patients with COVID-19 disease; case series from a tertiary care hospital in Pakistan. Epidemiol Infect 2021; 149: e37
    CrossrefPubMedSuche in Google Scholar
  • 54 Hui JY, Cho DH, Yang MK. et al. Severe acute respiratory syndrome: spectrum of high-resolution CT findings and temporal progression of the disease. AJR Am J Roentgenol 2003; 181 (06) 1525-1538
    CrossrefPubMedSuche in Google Scholar
  • 55 Koullias GJ, Korkolis DP, Wang XJ, Hammond GL. Current assessment and management of spontaneous pneumomediastinum: experience in 24 adult patients. Eur J Cardiothorac Surg 2004; 25 (05) 852-855
    CrossrefPubMedSuche in Google Scholar
  • 56 Macia I, Moya J, Ramos R. et al. Spontaneous pneumomediastinum: 41 cases. Eur J Cardiothorac Surg 2007; 31 (06) 1110-1114
    CrossrefPubMedSuche in Google Scholar
  • 57 Kobashi Y, Okimoto N, Matsushima T, Soejima R. Comparative study of mediastinal emphysema as determined by etiology. Intern Med 2002; 41 (04) 277-282
    CrossrefPubMedSuche in Google Scholar
  • 58 Iyer VN, Joshi AY, Ryu JH. Spontaneous pneumomediastinum: analysis of 62 consecutive adult patients. Mayo Clin Proc 2009; 84 (05) 417-421
    CrossrefPubMedSuche in Google Scholar
  • 59 Gulati U, Medeiros C, Nanduri A. et al. Understanding pneumomediastinum as a complication in patients with COVID-19: a case series. J Investig Med High Impact Case Rep 2022;10:23247096221127117
    PubMed
  • 60 Patel N, Nicolae R, Geropoulos G. et al. Pneumomediastinum in the COVID-19 era: to drain or not to drain?. Monaldi Arch Chest Dis 2022;93(02):
    PubMed
  • 61 Sundaralingam A, Bedawi EO, Rahman NM. Diagnostics in pleural disease. Diagnostics (Basel) 2020; 10 (12) 1046
    CrossrefPubMedSuche in Google Scholar
  • 62 Chong WH, Saha BK, Conuel E, Chopra A. The incidence of pleural effusion in COVID-19 pneumonia: state-of-the-art review. Heart Lung 2021; 50 (04) 481-490
    CrossrefPubMedSuche in Google Scholar
  • 63 Rathore SS, Hussain N, Manju AH. et al. Prevalence and clinical outcomes of pleural effusion in COVID-19 patients: a systematic review and meta-analysis. J Med Virol 2022; 94 (01) 229-239
    CrossrefPubMedSuche in Google Scholar
  • 64 Feng Y, Ling Y, Bai T. et al. COVID-19 with different severities: a multicenter study of clinical features. Am J Respir Crit Care Med 2020; 201 (11) 1380-1388
    CrossrefPubMedSuche in Google Scholar
  • 65 Wei XS, Wang X, Ye LL. et al. Pleural effusion as an indicator for the poor prognosis of COVID-19 patients. Int J Clin Pract 2021; 75 (06) e14123
    PubMedSuche in Google Scholar
  • 66 Chong WH, Huggins JT, Chopra A. Characteristics of pleural effusion in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia. Am J Med Sci 2021; 361 (02) 281-284
    CrossrefPubMedSuche in Google Scholar
  • 67 Bedawi EO, Ur Rehman K, Sivakumar DP. et al. The impact of the COVID-19 pandemic on pleural infection incidence: a UK multicentre retrospective analysis. ERJ Open Res 2022; 8 (03) 00206-2022
    CrossrefPubMedSuche in Google Scholar