Cervical pneumatocele: A case report and review of the literature.

A thyroidectomy is a safe and low-risk procedure done for a wide variety of thyroid disorders. Complications of a thyroidectomy are commonly due to damage of structures adjacent to the thyroid gland. In this case report, we present the case of a 39-year-old patient with a cervical pneumatocele a month after thyroidectomy for thyroid papillary carcinoma. The symptoms included neck swelling when speaking that resolved with rest. A follow-up neck CT scan found a collection of air anterior to the trachea most compatible with cervical pneumatocele. Exploratory surgery ensued and a pneumatocele arising from a tracheal subcutaneous fistula was cauterized. On follow-up laryngoscopy a month later, no further complications were found, and the patient reported resolution of symptoms. Tracheal injury following thyroidectomy is a rare complication and CT imaging can be helpful in diagnosing these complications and expediting management.

Recurrent spontaneous pneumothorax secondary to lung cystic lesions in a case of convalescent COVID-19: a case report and literature review.

BACKGROUND: While spontaneous pneumothorax has been documented in COVID-19 patients, reports on recurrent spontaneous pneumothorax due to cystic lesions in convalescent COVID-19 patients are scarce. The progression of these lung cystic lesions remains inadequately explored. CASE PRESENTATION AND LITERATURE REVIEW: An 81-year-old male, a non-smoker with a history of rheumatoid arthritis, presented with fever, cough, and expectoration for 14 days. Initially diagnosed with moderate COVID-19, he deteriorated to severe COVID-19 despite adherence to local treatment guidelines. Successive identification of three cystic lesions termed "bulla" or "pneumatocele", and one cystic lesion with air-fluid level, referred to as "pneumo-hamatocele" (PHC), occurred in his lungs. Gradual improvement followed anti-inflammatory therapy and optimal supportive care. However, on day 42, sudden worsening dyspnea prompted a computed tomography (CT) scan, confirming a right spontaneous pneumothorax and subcutaneous emphysema, likely due to PHC rupture. Discharge followed chest tube implementation for pneumothorax resolution. On day 116, he returned to the hospital with mild exertional dyspnea. Chest CT revealed recurrent right pneumothorax from a remaining cyst in the right lung. Apart from our patient, literature retrieval identified 22 COVID-19 patients with spontaneous pneumothorax due to cystic lesions, with a male predominance (95.6%; 22/23). Diagnosis of pneumothorax and lung cystic lesions occurred around day 29.5 (range: 18-35) and day 26.4 (± 9.8) since symptom onset, respectively. Except for one patient whose pneumothorax occurred on day seven of illness, all patients eventually recovered. CONCLUSIONS: Recurrent spontaneous pneumothorax secondary to lung cystic lesions may manifest in convalescent COVID-19 patients, particularly males with COVID-19 pneumonia. Chest CT around 2 to 3 weeks post-symptom onset may be prudent to detect cystic lesion development and anticipate spontaneous pneumothorax.

Resilience in the Face of Trauma: A Pediatric Case of Traumatic Pneumatocele.

Traumatic pneumatocele (TP) is a rare complication that can develop in the lungs following a traumatic event. These lesions are sometimes mistaken for congenital airway malformations. Multiple theories exist to explain the pathophysiology of this condition. This case study presents the clinical and radiological findings of a seven-year-old patient diagnosed with pneumatocele on thoracic imaging after a motor vehicle accident. A detailed evaluation of the patient's medical history and imaging led to the diagnosis of traumatic pneumatocele. This uncommon presentation, if not well understood, may lead to unnecessary interventions and significant anxiety for patients and their families. Given its rarity, awareness and a high index of suspicion are essential for accurate diagnosis and appropriate management.

[Cavitary lung lesions in COVID-19 associated pneumonia: a single-center study of 40 cases]. / Polostnye obrazovaniya legkikh pri COVID-19-assotsiirovannoi pnevmonii.

OBJECTIVE: To demonstrate clinical features and outcomes in patients with cavitary lung lesions and COVID-19 associated pneumonia. MATERIAL AND METHODS: A retrospective analysis of electronic medical records of 8261 patients with COVID-19 was performed. We selected 40 patients meeting the inclusion criteria. Sex, age, hospital-stay, lung tissue lesion, comorbidities, treatment, methods of respiratory support, complications and outcomes were evaluated. RESULTS: Cavitary lung lesions were more common in men (67.5%). Age of patients ranged from 28 to 88 (mean 64.9±13.7) years. Hospital-stay in patients with cavitary lung lesions was 9-58 (median 27.5) days. There were 18 complications in 14 (35%) patients. Pneumothorax, isolated pneumomediastinum, pleural empyema, hemoptysis and sigmoid colon perforation were considered as complications of cavitary lung lesions. Nine (22.5%) patients died (5 of them with complications). Three patients died after surgical treatment. Long-term results were analyzed in 8 (25.8%) patients. Patients were followed-up for 3 months after discharge. Shrinkage of lesions occurred after 7-60 (mean 23) days, and complete obliteration of cavities came after 32 (range 14-90) days. CONCLUSION: Cavitary lung lesions are a rare complication of COVID-19 pneumonia. There was no significant correlation of complications with age, sex, therapy, volume of lung lesions and non-invasive ventilation (NIV). Despite more common fatal outcomes in older patients undergoing NIV, the last one was prescribed exclusively due to disease progression and respiratory failure. Further research on this problem is necessary to identify possible risk factors of cavitary lung lesions.

[Risk factors of pulmonary cavitation in COVID-19 pneumonia]. / Faktory riska poyavleniya polostnykh obrazovanii legkikh pri COVID-19-pnevmonii.

OBJECTIVE: To identify the risk factors of pulmonary cavitation in COVID-19 pneumonia. MATERIAL AND METHODS: A retrospective study included 8261 patients with COVID-19 between April 2020 and March 2022. Inclusion criteria: age >18 years, COVID-19 confirmed by polymerase chain reaction. Two cohorts of patients were formed: 40 patients with pulmonary cavitation and 40 patients without these lesions. Both groups were comparable in age, lung lesion volume and oxygenation. Sex, age, length of hospital-stay, CT grade of lung lesion, comorbidities, treatment, respiratory support, oxygen saturation and in-hospital outcomes were evaluated. The highest lung lesion volume during hospitalization was assessed. CT was performed upon admission and approximately every 5 days for evaluation of treatment. Statistical analysis was performed using the IBM SPSS Statistics software (IBM Corporation, USA). RESULTS: Patients with pulmonary cavitation significantly differed in age, SpO2, lung lesion volume, more common non-invasive ventilation and prolonged hospital-stay. Cardiovascular diseases were more common in both groups. Univariate logistic regression analysis revealed age, cardiovascular diseases, CT-based severity of lung damage, absence of biological therapy and non-invasive ventilation as risk factors of pulmonary cavitation. According to multivariate logistic regression analysis, these predictors were CT-based severity of lung damage and absence of biological therapy. Univariate logistic regression analysis showed that pulmonary cavitation had no significant effect on mortality (OR=2.613, 95% CI: 0.732-9.322, p=0.139). CONCLUSION: The risk of pulmonary cavitation in COVID-19 is directly related to advanced lung damage and untimely or absent biological therapy with IL-6 inhibitors. Pulmonary cavitation in COVID-19 is not a typical manifestation of disease and can be caused by some factors: fungal infection, secondary bacterial infection, tuberculosis and pulmonary infarction. Further study of this problem is required to develop diagnostic algorithms and treatment tactics.

Development of pneumatocele and spontaneous pneumothorax as a late complication of COVID-19 pneumonia.

SARS-COV2 pandemic has spread like wildfire and has affected all the countries worldwide. The virus mainly affects the lungs and has numerous manifestations. The development of spontaneous pneumatocele and pneumothorax has rarely been reported in the literature, especially in spontaneously breathing patients. We report two cases of COVID-19 patients who developed these complications after discharge from our hospital. These complications are uncommon but can be potentially fatal and the treating physician should keep these complications as differential while managing such cases.

Pulmonary cyst newly formed after lobectomy in various underlying lung conditions.

BACKGROUND: It has been recently recognized that pulmonary cyst may develop after pulmonary resection, causing various symptoms. Most previously reported cases were after upper lobectomy in patients with chronic obstructive lung disease (COPD). CASE PRESENTATION: Case 1 was a man in his 70 s with interstitial pneumonia (IP). Right lower lobectomy was performed for metastatic lung tumor using video-assisted thoracoscopic surgery (VATS). On postoperative day (POD) 19, computed tomography (CT) revealed a large cyst at the upper interlobular surface of the middle lobe, with pneumoderma and pneumomediastinum. The cyst was incised, polyglycolic acid (PGA) sheet and fibrin glue were applied, and the cyst was sutured. The sutured line was covered again with PGA sheet and fibrin glue. Case 2 was a man in his 70 s with COPD. Right upper lobectomy for primary lung cancer was performed using VATS. On POD 17, CT revealed a large pulmonary cyst at the apex of S6 and massive air leakage was observed. The same surgical procedure as that used in case 1 was performed. Cases 3 and 4 were healthy donors for living-donor lung transplantation. Two months after the right lower lobectomy in Case 3 and 3 months after the left lower lobectomy in Case 4, the patients had respiratory symptoms such as dyspnea and hemosputum. CT revealed a large cyst on the diaphragmatic surface of the right middle lobe in Case 3 and on the posterior mediastinal surface of the left upper lobe in Case 4. Cyst incision, soft coagulation, and application of PGA sheet with fibrin glue were performed in both cases. CT performed 1 year after surgery showed no development of a pulmonary cyst or air space in these four cases. CONCLUSIONS: Pulmonary cysts newly formed after lobectomy can develop not only in COPD or IP but also in healthy lungs. Our findings suggest that incision of the cyst and application of fibrin glue and PGA sheet with or without suturing the cyst wall is effective for management.

Pop Goes the Lung: Bilateral Pneumothoraces Due to Delayed Pneumatocele Rupture in Coronavirus Disease 2019 (COVID-19).

Worldwide medical and scientific communities are focusing on further understanding coronavirus disease 2019 (COVID-19) complications and its long-term impact on survivors. Pneumatocele cases are being reported more as a consequence of this virus and a cause of pneumothorax in certain patients. In this case vignette, we present a previously healthy male with COVID-19 symptoms who required hospitalization for hypoxia and who required readmission for bilateral pneumothorax from the delayed rupture of pneumatoceles. We describe this rare pathology and provide hypotheses for possible etiologies.

Pneumatocele-induced pneumothorax after COVID-19 infection in a 45-day-old infant.

Throughout the literature, many pathologic lung lesions and complications following coronavirus disease 2019 (COVID-19) infection have been reported including pneumatocele formation which could potentially lead to pneumothorax development. This case report discusses the clinical course of a 45-day-old male with respiratory distress, whose condition worsened over time. Investigations revealed elevated COVID-19 immunoglobulin G (IgG) antibodies with negative COVID polymerase chain reaction (PCR) accompanied by radiologic evidence of pneumatocele formation, which was further complicated by pneumothorax. The clinical presentation of the patient was consistent with post-COVID infection but he had no history of contact with a sick individual which prompted further investigation of the source of the infection. Upon reviewing the history of the mother, symptoms consistent with COVID-19 around 32 weeks of pregnancy were revealed, which raises the possibility of maternal-fetal exchange of COVID-19 infection. This article presents the youngest reported patient with COVID-19 pneumonia that led to pneumatocele formation.

Emergent bedside management of a pneumatocele in a neonate via Fogarty catheter.

Persistent pneumatoceles in neonates increase mortality, and little literature regarding emergent treatment in a decompensating patient exists. We present the emergent management of a pneumatocele in a decompensating neonate by isolation with a Fogarty catheter.

Pneumatocele Manifestation in Early Recovery Period of COVID-19: A Case Study.

In this case report, we review a case of pneumatocele in a 54-year-old Caucasian male patient diagnosed with infection of COVID-19 29 days prior, presenting with complaints of dyspnea and sharp pleuritic chest pain located in the left mid-axillary region exacerbated by deep inspiration with an episode of significant forceful cough a day prior. Preliminary labs were unrevealing for leukocytosis or neutrophilia, with normal troponins, and COVID-19 negative upon presentation. Radiographic imaging was significant for bilateral infiltrates in the left upper lobe, air fluid levels with initial concern for abscess but with subsequent inference of pneumatocele. Imaging was negative for pneumothorax. The patient was monitored, remained stable throughout admission, and discharged after work-up for fungal and bacterial infection were found to be negative with expectation of self-resolution of the pneumatocele. In this study, we overview the pulmonary impact of COVID-19 in the scope of pneumatocele occurrence in the early recovery phase of the viral illness.

COVID-19-Associated Pneumatocele and Subsequent Pneumothorax.

We report a case of pneumatocele and subsequent pneumothorax, 20 days after being treated for coronavirus disease 2019 (COVID-19) and discharged. This 64-year-old patient was initially treated for COVID-19 pneumonia and pulmonary embolism (PE) over a two-week-long admission. He was discharged and then re-presented two days post-discharge with sudden exacerbation of breathlessness. Blood tests showed worsening inflammatory markers likely associated with bacterial infection, and imaging revealed multiple pneumatoceles and subsequent pneumothorax. Unfortunately, he rapidly deteriorated and passed away. This case report adds to the growing concern in the literature about the serious and life-threatening complications of COVID-19 infection and raises awareness of this rare complication.

Long term longitudinal follow-up of an AD-HIES cohort: the impact of early diagnosis and enrollment to IPINet centers on the natural history of Job's syndrome.

Job's syndrome, or autosomal dominant hyperimmunoglobulin E syndrome (AD-HIES, STAT3-Dominant Negative), is a rare inborn error of immunity (IEI) with multi-organ involvement and long-life post-infective damage. Longitudinal registries are of primary importance in improving our knowledge of the natural history and management of these rare disorders. This study aimed to describe the natural history of 30 Italian patients with AD-HIES recorded in the Italian network for primary immunodeficiency (IPINet) registry. This study shows the incidence of manifestations present at the time of diagnosis versus those that arose during follow up at a referral center for IEI. The mean time of diagnostic delay was 13.7 years, while the age of disease onset was < 12 months in 66.7% of patients. Respiratory complications, namely bronchiectasis and pneumatoceles, were present at diagnosis in 46.7% and 43.3% of patients, respectively. Antimicrobial prophylaxis resulted in a decrease in the incidence of pneumonia from 76.7% to 46.7%. At the time of diagnosis, skin involvement was present in 93.3% of the patients, including eczema (80.8%) and abscesses (66.7%). At the time of follow-up, under therapy, the prevalence of complications decreased: eczema and skin abscesses reduced to 63.3% and 56.7%, respectively. Antifungal prophylaxis decreased the incidence of mucocutaneous candidiasis from 70% to 56.7%. During the SARS-CoV-2 pandemic, seven patients developed COVID-19. Survival analyses showed that 27 out of 30 patients survived, while three patients died at ages of 28, 39, and 46 years as a consequence of lung bleeding, lymphoma, and sepsis, respectively. Analysis of a cumulative follow-up period of 278.7 patient-years showed that early diagnosis, adequate management at expertise centers for IEI, prophylactic antibiotics, and antifungal therapy improve outcomes and can positively influence the life expectancy of patients.

Abrupt Bulla Formation by Visceral Pleural Detachment after Pulmonary Lobectomy: A Case Report.

Pulmonary bullae usually grow slowly and have thin walls. However, we have observed 2 cases of abrupt bulla formation immediately after lobectomy and during surgery. The pathologic findings of what can be called visceral pleural detachment are quite distinctive: these bullae had a broad base connected to the lung, and their walls were thick, including the full extent of visceral pleural and peripheral alveolar tissues, which suggests that the visceral pleura were detached from the distal alveoli. High transpleural pressure might be the key factor in the pathogenesis of this type of bulla, unlike previously known types of bullous lung disease.

Multiple pneumatoceles and lung abscesses caused by early-onset E. coli sepsis in a preterm neonate.

Early-onset sepsis (EOS) is a serious and fatal illness in neonates, Group B Streptococcus and Escherichia coli are major causative pathogens. We report a case of EOS and pneumonia caused by E. coli in a preterm neonate with multiple pneumatoceles and lung abscesses. A male neonate weighing 1670g was delivered at 33 6/7 weeks' gestation by a mother with clinical chorioamnionitis. He showed respiratory distress soon after birth and developed septic shock. He was intubated and mechanical ventilation was started. E.coli was detected in blood culture obtained from both the patient and his mother. He developed multiple pneumatoceles and lung abscesses. Surgical drainage was complicated, cefotaxime was thus continued until day 74. Pneumatoceles and lung abscesses are complications of neonatal pneumonia, rarely reported by E. coli. Multiple lung abscesses in our patient are distinct from single abscesses in previous case studies of neonatal lung abscesses. We speculate that bacteremia along with pneumatoceles led to multiple lung abscesses in our patient. These complications require long-term antibiotic therapy, to minimize morbidity and mortality, and should thus be considered when managing EOS caused by E. coli.

Pneumosinus Dilatans: A Myriad of Symptomology.

Pneumosinus dilatans is an abnormal expansion of the air-filled paranasal sinuses. Usually found incidentally on radiology, it does rarely present in the form of cosmetic, neurological, ocular or rhinological pathologies. We report a case of a young male with complaints of bilateral gradual vision loss, diagnosed as pneumosinus dilatans with optic nerve atrophy. He underwent bilateral optic nerve decompression. A review of all cases of pneumosinus dilatans, reported over the last 100 years in English literature is presented.

Pneumatocele in a Ugandan female with SARS-CoV2 infection: A case report.

Pneumatocele may complicate the course of SARS-CoV2 infection. Our article exhibits the value of early radiological imaging for the timely diagnosis and management of COVID-19 and its complications. Conservative management is the mainstay of the treatment of pneumatoceles; however, prompt surgical intervention is imperative for complicated pneumatoceles.

Rapid development and rupture of a pneumatocele caused by pulmonary dissection in the early postoperative period of lung resection: a case report.

Air leakage after lung resection is a common complication usually caused by direct injury to the lung parenchyma. Herein we illustrate a case of pneumatocele that developed rapidly in the right middle lobe and ruptured 16 days after right upper lobectomy. A 73-year-old man with chronic obstructive pulmonary disease underwent thoracoscopic right upper lobectomy and partial thymectomy for primary lung cancer and thymic nodules, respectively. Although a small amount of air leakage was observed after the operation, air leakage completely improved on postoperative day (POD) 2, and the chest drain tube was removed on POD 3. The patient's condition was complicated with eosinophilic pneumonia. Steroid therapy was started on POD 13. Dyspnea suddenly developed immediately after defecation on POD 16. Computed tomography (CT) scan showed a large pneumatocele in the right middle lobe, which was not found by CT scan on POD 11. He underwent reoperation on POD 20, and a large thick-walled pneumatocele in the right middle lobe was directly sewn. Histopathologically, the wall of bulla consisted of thickened visceral pleura and thin lung parenchyma, suggesting that this pneumatocele was induced by dissection of subpleural lung parenchyma.

Acute exogenous lipoid pneumonia: Unusual presentation as cavitating lung disease with pneumothorax.

Acute lipoid pneumonia is quite uncommon and is associated with oily or lipid contents within the alveoli. Exogenous lipoid pneumonia due to kerosene poisoning, manifests with a wide clinical spectrum ranging from subtle chemical pneumonitis to marked severe pulmonary and systemic inflammation. We present an interesting case of an adult male with kerosene poisoning. He manifested with severe cavitating lung disease. In addition, he developed spontaneous pneumothorax. Both cavitating lung disease and pneumothorax are unusual manifestations of acute exogenous lipoid pneumonia and perhaps follow severe lung injury following high volume kerosene exposure.