A comparative study evaluating the outcome of patients with pneumothorax diagnosed with COVID-19 in Iraq.

Main Article Content

Dr. Wallaa Luay Alfalluji
Dr. Ali Salih Baay


Pneumothorax; PCR; chest CT; COVID-19; chest CT scan; and Hypertension


Introduction: The Covid-19 pandemic has caused 34,161,721 confirmed cases and more than 1016,986 deaths worldwide so far. However, others can cause serious complications that increase the death rate. Acute respiratory distress syndrome (ARDS) is a complication of this new virus belonging to the family of coronavirus, known as SARS-CoV-2, which is currently the most common
complication for patients admitted to an ICU. Another complication, although less common but with a significant impact on the patient's development, is a spontaneous pneumothorax in patients with Covid-19, with a rate of 1-2%. The pathogenesis and pathophysiology of pneumothorax in connection with Covid-19 is still not completely clear, and the possible causes are the formation of bubbles, pneumocele, the inflammatory process itself, and barotrauma.

Objective: This paper aims to conduct a comparative study evaluating the outcome of patients with pneumothorax diagnosed with COVID19 in Iraq.

Patients and Methods: A prospective and archaeological cohort study was conducted evaluating the outcome of patients with pneumothorax diagnosed with COVID-19 in Marjan Medical City/Babylon, Iraq, by adequate sampling from 800 inpatient files admitted from June 2020 through March 2021. A statistical study was conducted for patients using the SPSS program. The study population includes every patient who was admitted and diagnosed with COVID-19 by PCR or chest CT scan. Files lacking the necessary data were excluded from the study. Pneumothorax was defined as any CXR findings according to ATS criteria.

Results and discussions: The main cause of primary spontaneous pneumothorax in patients with Covid-19 is rupture of subdural bullae or pneumocele with CT findings. The diffuse alveolar damage caused by the excessive inflammatory process caused by the large amount of cytokines released by the COVID-19 virus leads to a weakening of the airway walls, in addition to acute respiratory distress syndrome, which leads to an increase in intra-alveolar pressure that prepares the alveoli to rupture, causing them to rupture. Air leakage into the interstitial space. Follow up to previous studies; previous studies showed that men are more affected than women, as this was confirmed by our study, as it reached 308, or 61.5% of females, while the percentage of males reached 492, or 61.5%. In addition, this study has shown that most patients has gotten the treatment with the exception of two types of treatment where the patients have gotten which are Decadron and enoxaparin.

Conclusion: Pneumothorax is a primary cause of acute respiratory distress syndrome, which raises the chances of mortality. The problem with pneumothorax in SARS-CoV-2 patients is that despite respiratory therapy and the use of neuromuscular blockers, patients still have a high prevalence of pneumothorax. This increased frequency is due to the fact that individuals infected with SARS-CoV2 require a larger positive end-expiratory pressure (PEEP). When the cases were combined, it became clear that if a patient had a pneumothorax, the likelihood of mortality rose with time.

Abstract 126 | pdf Downloads 78


1. Deshmukh V, Motwani R, Kumar A, et al.. Histopathological observations in COVID-19: a systematic review. J Clin Pathol 2021;74:76–83.
2. Iba T, Connors JM, Levy JH. The coagulopathy, endotheliopathy, and vasculitis of COVID19. Inflamm Res 2020;69:1181–9. 10.1007/s00011-020-01401-6
3. Chen N, Zhou M, Dong X, et al.. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020;395:507–13. 10.1016/S0140-6736 (20)30211-7
4. Yang X, Yu Y, Xu J, et al.. Clinical course and outcomes of critically ill patients with SARSCoV-2 pneumonia in Wuhan, China: a singlecentered, retrospective, observational study. Lancet Respir Med 2020;8:475–81. 10.1016/S2213-2600 (20)30079-5
5. Yang F, Shi S, Zhu J. Analysis of 92 deceased patients with COVID-19. J Med Virol 2020.
6. Martinelli AW, Ingle T, Newman J, et al.. COVID-19 and pneumothorax: a multicentre retrospective case series. Eur Respir
J 2020;56:2002697. 10.1183/13993003.02697-2020
7. McGuinness G, Zhan C, Rosenberg N, et al.. Increased incidence of barotrauma in patients with COVID-19 on invasive mechanical
ventilation. Radiology 2020;297:E252–62. 10.1148/radiol.2020202352
8. Abate SM, Ahmed Ali S, Mantfardo B, et al.. Rate of intensive care unit admission and outcomes among patients with coronavirus: a systematic review and meta-analysis. PLoS One 2020;15:e0235653. 10.1371/journal.pone.0235653
9. Zantah M, Dominguez Castillo E, Townsend R, et al.. Pneumothorax in COVID-19 diseaseincidence and clinical characteristics. Respir
Res 2020;21. 10.1186/s12931-020-01504-y
10. Marciniak SJ, Farrell J, Rostron A, et al.. COVID19 pneumothorax in the UK: a prospective observational study using the ISARIC who clinical
characterisation protocol. Eur Respir J 2021;58:2100929. 10.1183/13993003.00929-2021
11. Wang X-H, Duan J, Han X, et al.. High incidence and mortality of pneumothorax in critically ill patients with COVID-19. Heart Lung 2021;50:37–43. 10.1016/j.hrtlng.2020.10.002
12. Rees EM, Nightingale ES, Jafari Y, et al.. COVID19 length of hospital stay: a systematic review and data synthesis. BMC Med 2020;18:270.
13. Sancho J, Ferrer S, Lahosa C, et al.. Tracheostomy in patients with COVID-19: predictors and clinical features. Eur Arch Otorhinolaryngol 2021;278:3911–9. 10.1007/s00405-020-06555-x
14. MacDuff A, Arnold A, Harvey J, Group, B. P. D. G. Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010. Thorax. 2010;65:ii18–31.
15. Zhou C, Gao C, Xie Y, Xu M. COVID-19 with spontaneous pneumomediastinum. Lancet Infect Dis. 2020;20:510.
16. Wang J, Su X, Zhang T, Zheng C. Spontaneous Pneumomediastinum: a probable unusual complication of coronavirus disease 2019
(COVID-19) pneumonia. Korean J Radiol. 2020;21:627–8.
17. Sun R, Liu H, Wang X. Mediastinal emphysema, Giant Bulla, and pneumothorax developed during the course of COVID-19 pneumonia. Korean J Radiol. 2020;21:541.
18. Chen N, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395:507–13.
19. Yang F, et al. Analysis of 92 deceased patients with COVID-19. J Med Virol. 2020. https://doi.org/10.1002/jmv.25891.
20. Das KM, et al. Acute Middle East respiratory syndrome coronavirus: temporal lung changes observed on the chest radiographs of 55 patients. AJR Am J Roentgenol. 2015;205:W267–74.
21. Wang W, Gao R, Zheng Y, Jiang L. COVID-19 with spontaneous pneumothorax, pneumomediastinum, and subcutaneous emphysema. J Travel Med. 2020. https://doi.org/10.1093/jtm/taaa062.
22. Liu K, et al. COVID-19 with cystic features on computed tomography: a case report. Medicine. 2020;99:e20175.
23. Hosseiny M, Kooraki S, Gholamrezanezhad A, Reddy S, Myers L. Radiology perspective of coronavirus disease 2019 (COVID-19): lessons
from severe acute respiratory syndrome and Middle East respiratory syndrome. Am J Roentgenol. 2020;214:1078–82.
24. Albelda SM, Gefter WB, Kelley MA, Epstein DM, Miller WT. Ventilator-induced subpleural air cysts: clinical, radiographic, and pathologic Significance1. Am Rev Respir Dis. 2015;127:360–5.
25. Guan W-J, et al. Clinical characteristics of coronavirus disease 2019 in China. New Engl J Med. 2020;382:1708–20.
26. Tian S, et al. Characteristics of COVID-19 infection in Beijing. J Inf Secur. 2020;80:401–6.