Spontaneous Pneumothorax in Covid-19 Pneumonia. Case report

Coronavirus caused an epidemic in China in December 2019 at an animal market where live and dead animals were sold in Wuhan, China. In a short time, this epidemic spread to different continents. This virus has been called the 2019 new coronavirus (2019-nCoV) by the World Health Organization. Unlike both MERSCoV and SARS-CoV, Covid-19 is the seventh member of the coronavirus family that infects humans. It is characteristic for Covid-19 pneumonia that there are subpleural localized ground glass opacities and numerous irregular areas of consolidation in both lungs and especially in the lower lobes.In this case study, we aimed to present a Covid-19 positive in 58 years old man patient with cough, high fever, beginning breathlessness and chest pain on the left, accompanied by pneumothorax in the left hemithorax, after covid -19 diagnosis. Radiographic imaging of the patient revealed pneumothorax on the left and ground-glass opacities in the bilateral lower lobes. The patient underwent tube thoracostomy from the left hemithorax lateral. It should be kept in mind that in patients with Covid-19 pneumonia, it may develop in pneumotoacies secondary to lung parenchymal damage. Mortality rates can be reduced in patients with early diagnosis and treatment.


Introduction
A new case of Coronavirus infection, occurred in Wuhan, in China, in December 2019. On January 2020, this corona virus identified, was called 2019-nCoV [1].
Coronaviruses are enveloped RNA viruses that cause respiratory, enteric, hepatic, and neurological diseases that are common among birds, humans, and other mammals [2].
Up to now, are known six coronavirus species to cause human disease. The four common types cause common cold symptoms. The other two types of severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) are of zoonotic origin and can cause fatal diseases [3].
Although the mortality of Covid-19 is lower than that of SARS-CoV and MERS-CoV, the number of confirmed Covid-19 cases has increased significantly [4].
As of August 9, 2020, a total of Coronavirus Cases 19,918,709 and 731,718 deaths were reported worldwide [5,6].
Radiological imaging plays an important role in the diagnosis and treatment of pneumonia, which is the clinical presentation of Covid-19 [7]. Chest radiographs show low-density pneumonia foci (viral pneumonia), which mostly involve bilateral mid-lower zones in this disease.

Case Report
A 58-year-old male patient was admitted in July to the emergency department with complaints of fever, cough, shortness of breath and increased pain in the left hemithorax. His general condition was not good, inconscious, noncooperative and nonorientated with diabetes with insulinotherapy since 3 years and hypertension equilibrated. Blood pressure arterial 150/90 mmHg, pulse 92/min, respiratory rate 20/min, fever 38.5°C, oxygen saturation (SpO2) with finger probe was 50%. On radiological examination of the patient, consolidation and ground glass images were observed in the bilateral lower lobes and the accompanying left pneumothorax (Figure 1, 2, 3, 4).
The patient was admitted in the intensive care unit and the ts situation was improving day by day.but 4 days after the hospitalisation a left pneumothorax occured Covid-19 positive was detected in the polymerase chain reaction analysis (PCR).
Other vital signs were observed stably. There was no reproduction in the blood culture of the patient.
The control arterial blood gas was pH 7.32, PCO2 60.4, PO2 78.6. Vital findings remained stable. Six after the hospitalisation a left pneumothorax occured.In the linea axillaris medioanterior, space 4-5, with local anesthesia, a pleural dranaige was performermed.
Treatment and follow-up of the patient continues.

Discussion
The new coronavirus was identified and isolated by three groups of Chinese scientists. A consortium coordinated by W. Tan from the China Centers for Disease Control and Prevention (China CDC) achieved eight complete viral genome sequences by sequencing from RNA isolation and bronchoalveolar lavage fluid (BALF) in nine patients [8].  [10].

Conclusion:
In this study, we present a 58-year-old man patient with Covid-19 pneumonia and pneumothorax. We discussed the patient and his radiological findings in the light of the literature. Pneumothorax may develop in Covid-19 pneumonia due to alveolar damage. This can cause increased mortality and morbidity. For this reason, pneumothorax should be kept in mind in the treatment and follow-up of Covid-19 infection.