Air Leak Due COVID-19 in a Lung Cancer Patient.
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Authors
Aujayeb, Avinash
Issue Date
2021
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Abstract
Introduction: Covid-19 causes widespread pneumonitis which carries high mortality and morbidity in patients with lung cancer. About 1% of patients will develop a pleural complication of Covid-19, which is often in the form of pneumothorax or pneumomediastinum. Case series have described these as adverse prognostic markers.
Methods: We describe the case of a 76-year-old woman who was diagnosed in early December 2020 with T4 N2 M0 right upper lobe lung cancer. Her performance status was 0. Whilst awaiting an EBUS, in late Dec 2020, she presented with haemoptysis and facial swelling. A swab PCR was positive for Covid-19. She underwent an urgent CT scan (Figure 1) which showed widespread surgical emphysema and pneumomediastinum without pneumothorax. There was no associated pneumonitis. The lung cancer had not grown in size.
Results: She was significantly hypoxic with oxygen saturations of 90% on a 15L non-rebreathe bag. There was no intervention possible and a patient centred decision was made for palliation of symptoms. Her chosen place of death was at home: she was thus discharged with community support and died within 24 hours.
Conclusion: Pneumothoraces can be drained with intercostal tubes, and surgical emphysema can require subcutaneous tunnelled drains. However, pneumomediastinum and surgical emphysema due to Covid-19 carries a poor prognosis (even without a lung cancer diagnosis) [unpublished local data] unless mechanical ventilation is possible (1). Air leaks in the context of Covid-19 are rare. Isolated pneumothorax and pneumomediastinum are not adverse prognostic signs, but the development of pneumothorax, surgical emphysema and pneumomediastinum on mechanical or non-invasive ventilation might be as 12 of the 14 cases locally have died.
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Citation
Aujayeb, A. (2021) P33.01 Air Leak Due COVID-19 in a Lung Cancer Patient. Journal of Thoracic Oncology; 16 (10) : S1059.
Publisher
Journal of Thoracic Oncology
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ISSN
1556-1380