Characteristic features of the course of pneumothorax in patients with a new coronavirus infection
ORIGINAL PAPERS
Abstract
Introduction. The incidence of pneumothorax in the population is relatively high; however, reliable statistical data on its occurrence and standardized treatment approaches in coronavirus infection are lacking, which underscores the need for research. The aim is to study the incidence, progression and outcomes of pneumothorax, to formulate the main points of patient management strategies. Materials and methods. The study was conducted at the Clinical Infectious Diseases Hospital named after S.P. Botkin from 09/01/2020 to 09/01/2025. A total of 20432 patients were treated with a new coronavirus infection, among them 116 patients were diagnosed with pneumothorax. Results. The study examined the features of pneumothorax in patients with COVID-19, including clinical presentation, prevalence, risk factors, and outcomes. Right-sided pneumothorax was most common — 55%, left-sided accounted for 37%, and bilateral for 8%. The volume of the affected pleural cavity ranged from apical to total lung collapse. Among HIV-infected patients, a high frequency of pneumothorax (39%) was observed, especially in cases of co-infections such as tuberculosis and Pneumocystis pneumonia. Age distribution showed a predominance of young patients (65%). Disease progression was complicated by comorbidities, including cardiovascular and respiratory diseases, as well as abscess-forming pneumonia. Diagnosis was based on chest X-ray and computed tomography. The primary treatment involved pleural drainage, sometimes combined with pleurodesis and endoscopic occlusion. Early initiation of antiretroviral therapy in HIV-positive patients was a crucial aspect. Most patients were discharged with outpatient pulmonology follow-up, while some were transferred to other hospitals for specialized treatment unrelated to the primary disease. The mortality rate was relatively high. Conclusions. The results indicate that pneumothorax most often develops in young individuals, regardless of the severity of lung damage, and requires a comprehensive treatment approach, especially in immunocompromised patients.
References
1. Сушко А.А. Хирургия спонтанного пневмоторакса. Журнал Гродненского государственного медицинского университета. 2005;4:25–28.
2. Аникин Д.А., Демко И.В., Мамаева М.Г. и др. Клинический случай течения муковисцидоза, осложненного АА-амилоидозом, у взрослого пациента. Практическая пульмонология. 2024;1:40–44.
3. Humair G., Daccord C., Lazor R. Spontaneous pneumothorax: new concepts and current management. Revue Medicale Suisse. 2023;19(850):2146–2152.
4. Farronato A., Travaglia C., Ravasin A. et al. Patients with coronavirus disease 2019 and spontaneous pneumothorax: a propensity-matched, multicentre case-control study. Interdisciplinary Cardiovascular Thoracic Surgery. 2025;40(5):70–76.
5. Arellano G., Constantino J.M., Reyes J.M. et al. Spontaneous pneumomediastinum. A review with an illustrative case report. Acta Médica Grupo Ángeles. 2017;15(4):287–295.
6. Бродская О.Н. Спонтанный пневмоторакс. Атмосфера. Пульмонология и аллергология. 2006;4:53–55.
7. Шевченко Ю.Л., Аблицов Ю.А., Василашко В.И. и др. Влияние срока выполнения оперативных вмешательств по профилактике рецидивов первичного спонтанного пневмоторакса на течение раннего послеоперационного периода и отдаленные результаты. Вестник Национального медико-хирургического Центра им. Н.И. Пирогова. 2015;10(2):36–41.
8. How C.H., Hsu H.H., Chen J.S. Chemical pleurodesis for spontaneous pneumothorax. Journal of the Formosan Medical Association. 2013;112(12):749–755.
9. Михеев А.В. Этиология первичного спонтанного пневмоторакса (обзор литературы). Земский Врач. 2015;4(28):14–19.
10. Fujita K., Iwata T., Kanai O. et al. Clinical features of pneumothorax associated with COVID-19: A retrospective analysis of two centres. Respiratory Investigation. 2024;62(1):137–141.
11. Miró Ò., Llorens P., Jiménez S. et al. 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(3):1241–1255.
12. Martinelli A.W., Ingle T., Newman J. et al. COVID-19 and pneumothorax: a multicentre retrospective case series. European Respiratory Journal. 2020;56(5):1–10.
13. Song M.J., Kang M., Song K.H. et al. Comparison of the risk of pneumothorax in COVID-19 and seasonal influenza. Scientific Reports. 2024;14(1):21077.
14. Murawska Baptista A., Sinclair De Frías J., Singh T. et al. Pneumothorax, pneumomediastinum, and subcutaneous emphysema in hospitalized COVID-19 patients: incidence, clinical characteristics, and outcomes. Expert Review of Respiratory Medicine. 2023;7(8):727–733.
15. Rawal P., Shrestha S.M., Gurung A. et al. Pneumothorax, pneumomediastinum and subcutaneous emphysema as respiratory complications of COVID-19. Journal of Nepal Health Research Council. 2024;21(3):428–438.
16. Mc Guinness G., Zhan C., Rosenberg N. et al. Increased Incidence of Barotrauma in Patients with COVID-19 on Invasive Mechanical Ventilation. Radiology. 2020;297(2):252–262.
17. Belletti A., Landoni G., Zangrillo A. Pneumothorax and barotrauma in invasively ventilated patients with COVID-19. Respiratory Medicine. 2021;187:3642–3651.
18. Swain S.K., Behera I.C., Das S.R. Incidence of subcutaneous emphysema in the head, neck and thoracic region of intubated covid-19 patients: our experiences. International Journal of Current Research and Review. 2021;13:19–24.
19. Marwah V., Choudhary R., Peter D., Bhati G. COVID-19 ARDS-related pneumomediastinum and pneumothorax. Medical Journal Armed Forces India. 2021;77(2):515–516.
20. Chandna S., Raj K., Agrawal A. et al. Prevalence and patient risk factors for pneumothorax in COVID-19 and in influenza pneumonia: a nationwide comparative analysis. Journal of Thoracic Disease. 2024;16(6):3593–3605.
21. Özgel M., Gülçek I., Ağar M., Ulutaş H. Pneumothorax as a Poor Prognostic Indicator in COVID-19 in Turkey: A Propensity Score Matching Analysis. Nigerian Journal of Clinical Practice. 2024;27(8):958–964.
22. Taha M., Elahi M., Wahby K., Samavati L. Incidence and risk factors of COVID-19 associated pneumothorax. Public Library of Science ONE. 2022;17(8):1–12.
23. Marwah V., Choudhary R., Peter D., Bhati G. COVID-19 ARDS-related pneumomediastinum and pneumothorax. Medical Journal Armed Forces India. 2021;77(2):515–516.
24. Nasrullah A., Quazi M.A., Virk S. et al. Impact of pneumothorax on mortality, morbidity, and hospital resource utilization in COVID-19 patients: a propensity matched analysis of nationwide inpatient sample database. BMC Pulmonary Medicine. 2024;24(1):371–382.
25. Thombare B.D., Jain S.K. Subcutaneous emphysema, pneumomediastinum and pneumothorax in COVID-19 pneumonia-independent prognostic factors. Indian Journal of Thoracic and Cardiovascular Surgery. 2024;40(1):64–67.
