Abbreviations: ALT, alanine aminotransferase; AST, aspartate
aminotransferase; CRP, C-reactive protein.
The patient was admitted to the intensive care unit as a case of severe
COVID-19 pneumonia. As per the institutional protocol at the time, he
was treated with intravenous (IV) ceftriaxone, azithromycin,
methylprednisolone (40 mg every 12 hourly), and IV Remdesivir. Despite
treatment, the patient’s condition did not improve. The patient received
multidisciplinary care throughout his admission, including
physiotherapy, occupational therapy, respiratory therapy, critical care,
and infectious disease. On Day 8 of ICU stay, due to persistently high
oxygen requirements and increasing D-dimers (peak 8 mg/L FEU), a CT
pulmonary angiogram (CTPA) was performed to rule out pulmonary embolism.
The scan showed no filling defect but showed predominantly peripheral
and patchy basal areas of ground-glass attenuation with multifocal
segmental dense consolidation with air bronchograms, consistent with
severe bilateral pneumonia due to COVID-19. In this situation
O2saturation and blood pressure dropped and CT-scan of chest performed
and show tension pneumopricadium (FigE,F). patient as soon as possible
referred to ICU with CPAP and bilateral chest tube was insert in third
intercostal space in mid clavicular line and bilateral subclavicular
incision for evacuation of subcutaneous air the condition of patient
improved over the next 8 days, the patient’s pneumeditiastinum
moderately improved with decreased oxygen requirement(G,H,K,L). However,
due to persistent shortness of breath, oxygen requirement, and
persistent bubbling of chest tube, pleurodesis with autologous blood and
providon iodine(6,11) the air bubbling was not stopped. The patient’s
chest tube could not be removed till two months later when his
pneumediastinum resolved, and he started to maintain normal oxygen
saturation in room air. He was discharged after ward in an asymptomatic
condition with bilateral chest rube which connected to urine bag and 45
days chest tubes was removed with no evidence of pneumeditiastinum and
pneumothorax recurrence during four months following(Fig M,N,O,P) but
patchy infiltration not improved.