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Table of Contents
CASE REPORT
Year : 2022  |  Volume : 11  |  Issue : 5  |  Page : 50-52

Pulmonary cavity in a COVID-19 patient


Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India

Date of Submission03-Aug-2021
Date of Decision12-Jan-2022
Date of Acceptance24-Jan-2022
Date of Web Publication30-Aug-2022

Correspondence Address:
R Ram
Professor, Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati 517 507, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcsr.jcsr_47_21

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  Abstract 


Even though a small number of published single patient reports have more recently reported pulmonary cavitation in COVID-19 disease, it is still considered a rare radiology feature. We report a 45-year-old man with COVID 19 disease and a pulmonary cavity.

Keywords: Computed tomography scan, COVID-19, pulmonary cavity


How to cite this article:
Bharathi M D, Niharika K, Prakhya L, Gaddam SL, Mathini S, Kumar N P, Ram R, Kumar V S. Pulmonary cavity in a COVID-19 patient. J Clin Sci Res 2022;11, Suppl S1:50-2

How to cite this URL:
Bharathi M D, Niharika K, Prakhya L, Gaddam SL, Mathini S, Kumar N P, Ram R, Kumar V S. Pulmonary cavity in a COVID-19 patient. J Clin Sci Res [serial online] 2022 [cited 2022 Oct 2];11, Suppl S1:50-2. Available from: https://www.jcsr.co.in/text.asp?2022/11/5/50/355062




  Introduction Top


Cavitary lung lesions are usually related to mycobacterial, parasitic, fungal, autoimmune, neoplastic aetiologies or pulmonary embolism. Typical computed tomography (CT) imaging features of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) mainly include bilateral, subpleural, peripheral ground-glass opacities (GGO); crazy paving appearance (GGOs and inter-/intra-lobular septal thickening); air space consolidation; bronchovascular thickening in the lesion; traction bronchiectasis.[1],[2],[3],[4],[5]

A small number of published single patient reports have more recently reported pulmonary cavitation in COVID-19 disease.[6],[7],[8] pulmonary cavitation is still considered a rare radiology feature. We report a COVID-19 patient with the pulmonary cavity.


  Case Report Top


A 45-year-old man, farmer by occupation presented with, chief complaints of fever and cough of 4 days and breathlessness of 1 day duration. Fever was insidious in onset, high grade, intermittent type, not associated with chills and rigors, associated with body pains, relieved by taking paracetamol. Cough was insidious in onset, associated with expectoration. Sputum is scanty, mucoid type, non-foul smelling, not blood stained. The breathlessness of one day duration, sudden in onset, gradually progressed from Grade 3 to Grade 4, MMRC classification. No history of sore throat, running nose, loss of smell, loss of taste, orthopnoea or paroxysmal nocturnal dyspnoea. He tested COVID-19 positive by real-time polymerase chain reaction (RT-PCR). At admission, the pulse 88 beats per minute, blood pressure: 126/80 mm Hg, oxygen saturation by pulse oximetry (SpO2) 96% on room air, respirations 28 cycles per minute. CT of chest obtained a day before admission revealed CT severity score 24/25, multiple GGOs diffusely scattered in both the lungs, a thick-walled with air-fluid level in noted in posterobasal segment of the right lower lobe [Figure 1]. He had no history of tuberculosis, chronic obstructive pulmonary disease and bronchial asthma. He was neither a diabetic nor an hypertensive. He had no vices.
Figure 1: Computed tomography scan chest axial section (a), coronal section showing a thick walled with air fluid level in posterobasal segment of the right lower lobe (b)

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The patient required non-invasive ventilation for ten days. Later, he was on non-rebreather mask for thirty days. The oxygen requirement reduced slowly to 5 L/min at the time of discharge after forty five days. A repeat CT of the chest at discharge revealed the same cavity with the reduction in dimensions. The treatment included injection remedisivir and injection azithromycin for ten days and low-molecular-weight heparin and dexamethasone till the discharge. The investigations are tabulated [Table 1].
Table 1: Laboratory investigations

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Previous published reports of pulmonary cavities in patients with COVID-19 are shown in [Table 2].[6],[7],[8]
Table 2: Published reports documentig pulmonary cavities in coronavirus disease-2019

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  Discussion Top


A cavity is defined as an air-filled space within an area of pulmonary consolidation, mass or nodule, as a result of liquefication of the necrotic portion of the lesion and the discharge of this necrotic material via the bronchial tree. Our patient had a similar air-filled space in a region of GGO. Lung cavity is not ordinarily encountered in viral pneumonias,[9] including those due to the other human coronaviruses SARS-CoV-2[10] and middle east respiratory syndrome (MERS)-CoV.[11] Investigations required to exclude bacterial, tuberculosis and fungal co-infection as the cause of pulmonary cavity has been done. Intriguing and what should weigh in our minds is that the pulmonary cavity was present in the CT of the chest taken a day before admission to our institute, immediately after the RT-PCR for SARS-COV-2 returned positive. The patient received treatment in the hospital for 45 days. Our patient received dexamethasone during his hospital stay. Steroids suppress the immune system by impairing innate immunity. The corticosteroid usage could have explained the coinfection but not as a predisposing factor for the cavity when it was present even before the use of the steroids.

Cavitary lung disease has the risk of causing pneumothorax, by the extension of cavitary lesions to the pleural surface and by subsequent by rupture of the thin cavity walls. Cavities may predispose to fungal and bacterial lesions. Cavities could be the site of origin of haemoptysis. Our patient, by providence, could be discharged without any of these complications. Notwithstanding that the exact pathogenesis of pulmonary cavitation in COVID-19 requires to be deciphered and not many reports of pulmonary cavitation in COVID-19 disease had been published, all patients including our patient had uneventful recovery.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

The authors are faculty members/Undergraduate/postgraduate students/residents of Sri Venkateswara Institute of Medical Sciences, Tirupati, of which Journal of Clinical and Scientific Research is the official Publication. The article was subject to the journal's standard procedures, with peer review handled independently of these faculty and their research groups.



 
  References Top

1.
Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020;323:1061-9.  Back to cited text no. 1
    
2.
Pan F, Ye T, Sun P, Gui S, Liang B, Li L, et al. Time course of lung changes at chest CT during recovery from coronavirus disease 2019 (COVID-19). Radiology 2020;295:715-21.  Back to cited text no. 2
    
3.
Shi H, Han X, Jiang N, Cao Y, Alwalid O, Gu J, et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: A descriptive study. Lancet Infect Dis 2020;20:425-34.  Back to cited text no. 3
    
4.
Lee EY, Ng MY, Khong PL. COVID-19 pneumonia: What has CT taught us? Lancet Infect Dis 2020;20:384-5.  Back to cited text no. 4
    
5.
Zhao W, Zhong Z, Xie X, Yu Q, Liu J. Relation between chest CT findings and clinical conditions of coronavirus disease (COVID-19) pneumonia: A multicenter study. AJR Am J Roentgenol 2020;214:1072-7.  Back to cited text no. 5
    
6.
Chen Y, Chen W, Zhou J, Sun C, Lei Y. Large pulmonary cavity in COVID-19 cured patient case report. Ann Palliat Med 2021;10:5786-91.  Back to cited text no. 6
    
7.
Chen J, Peng S, Zhang B, Liu Z, Liu L, Zhang W. An uncommon manifestation of COVID-19 pneumonia on CT scan with small cavities in the lungs: A case report. Medicine (Baltimore) 2020;99:e21240.  Back to cited text no. 7
    
8.
Angirish B, Parmar K. Lung cavitation – A rare complication in COVID-19 patients: A case report. Arch Pulmonol Respir Care 2020;6:78-80.  Back to cited text no. 8
    
9.
Koo HJ, Lim S, Choe J, Choi SH, Sung H, Do KH. Radiographic and CT features of viral pneumonia. Radiographics 2018;38:719-39.  Back to cited text no. 9
    
10.
Wong KT, Antonio GE, Hui DS, Lee N, Yuen EH, Wu A, et al. Severe acute respiratory syndrome: Radiographic appearances and pattern of progression in 138 patients. Radiology 2003;228:401-6.  Back to cited text no. 10
    
11.
Ajlan AM, Ahyad RA, Jamjoom LG, Alharthy A, Madani TA. Middle East respiratory syndrome coronavirus (MERSCoV) infection: Chest CT findings. AJR Am J Roentgenol 2014;203:782-7.  Back to cited text no. 11
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2]



 

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