A case of secondary tension pneumothorax in COVID-19 pneumonia in a patient with no prior history of lung disease

Complications that arise in patients with severe COVID-19 pneumonia are acute respiratory distress syndrome, often leading to mechanical ventilation, shock requiring vasopressors, acute kidney injury, stroke, thromboembolic phenomena, and myocardial injury. To date, there are four cases of tension pneumothorax in patients with COVID-19, published in literature. We present a 33-year-old man with no prior history of lung disease who was admitted to our hospital on account of hypoxic respiratory failure secondary to COVID-19 pneumonia. During his hospitalization, he developed sudden onset of chest pain which worsened with coughing. A chest X-ray showed a right-sided pneumothorax with left-sided mediastinal shift. He required placement of chest tubes with eventual resolution of the pneumothorax several days later. This case highlights the need for clinical recognition, consideration of differential diagnoses, prompt evaluation, appropriate imaging, and management of this severe life-threatening unusual complication of COVID-19 pneumonia.