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Reminder of important clinical lesson
Case report
Tension pneumothorax in a patient with COVID-19
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  1. Luke Flower1,
  2. John-Paul L Carter2,
  3. Juan Rosales Lopez2 and
  4. Alun Marc Henry2
  1. 1 Anaesthesia, University College London Hospitals NHS Foundation Trust, London, UK
  2. 2 Emergency Department, University College London Hospitals NHS Foundation Trust, London, UK
  1. Correspondence to Dr Luke Flower; luke.flower{at}doctors.org.uk

Abstract

A 36-year-old man was brought to the emergency department with suspected COVID-19, following a 3-week history of cough, fevers and shortness of breath, worsening suddenly in the preceding 4 hours. On presentation he was hypoxaemic, with an SpO2 of 88% on 15 L/min oxygen, tachycardic and had no audible breath sounds on auscultation of the left hemithorax. Local guidelines recommended that the patient should be initiated on continuous positive airway pressure while investigations were awaited, however given the examination findings an emergency portable chest radiograph was performed. The chest radiograph demonstrated a left-sided tension pneumothorax. This was treated with emergency needle decompression, with good effect, followed by chest drain insertion. A repeat chest radiograph demonstrated lung re-expansion, and the patient was admitted to a COVID-19 specific ward for further observation. This case demonstrates tension pneumothorax as a possible complication of suspected COVID-19 and emphasises the importance of thorough history-taking and clinical examination.

  • emergency medicine
  • respiratory medicine
  • intensive care
  • infectious diseases

This article is made freely available for use in accordance with BMJ's website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/bcr-2020-235861

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    Footnotes

    • Twitter @LukeFlower1

    • Contributors LF was the lead author for this case report, leading the initial patient care and management, and leading the writing of the mansucript. AMH was the consultant in charge during the case, was actively involved in decision making and patient treatment, and contributed to the manuscript. JRL was the senior registrar on call, he was actively involved in patient treatment and contributed to the manuscript. J-PLC was one of the emergency department SHOs on call, he played a significant part in the write up of the manuscript, as well as aiding with translation and patient communication.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.