https://orcid.org/0000-0001-9542-5199
A 56-year-old man was brought into our primary percutaneous coronary intervention (PCI) centre with a suspected acute myocardial infarction (AMI).
He presented with a 3-week history of anosmia, hypogeusia, lethargy, fever, and persistent cough, culminating in acute-onset chest pain and syncope. In 2017, he had suffered an anterior AMI, undergoing PCI to the left anterior descending artery. This was complicated by a left ventricular (LV) thrombus that resolved with 12 months of anticoagulation, which was then discontinued. The 12-lead electrocardiogram (ECG) did not show ST-segment elevation, and bedside echocardiography failed to produce cardiac imaging from standard views. On examination, he was hypotensive (82/60 mmHg) and hypoxic (SpO2 88%) with unequal chest expansion and reduced air entry on the left.
An urgent chest radiograph confirmed a left-sided spontaneous tension pneumothorax (Panel A). He had an emergency surgical chest drain resulting in immediate clinical improvement. D-dimer was elevated (7480 ng/mL). The computed tomography pulmonary angiogram (CTPA) showed subsegmental pulmonary emboli (Panel B, asterisks), residual pneumothorax with surgical emphysema, and bilateral consolidation in bronchocentric and peripheral distributions, associated with traction bronchiectasis (Panel C). An apical LV thrombus (28 × 21 × 18 mm) was also identified, as demonstrated by multiplanar 3D image reconstruction (Panels D and E, arrowhead) and transthoracic echocardiography (Supplementary material online, Video 1). Anticoagulation was commenced and he was discharged home after complete resolution of the pneumothoax. His initial SARS-CoV-2 PCR was negative but he subsequently tested positive on day 4.
This is the first reported case of a spontaneous pneumothorax associated with multiple thrombotic complications of COVID-19. It highlights the importance of recognizing life-threatening and multisystemic manifestations of COVID-19 in patients presenting to a PCI centre.
Supplementary material is available online at European Heart Journal – Cardiovascular Imaging.
This work was part-funded by a King’s College Hospital R&D Grant and was supported by the Department of Health via a National Institute for Health Research Biomedical Research Centre award to Guy’s & St Thomas’ NHS Foundation Trust in partnership with King’s College London and King’s College Hospital NHS Foundation Trust.
Conflict of interest: none declared.
Consent: Informed consent was obtained from the patient.
