Development of a Large Pneumatocele in a Patient Recovering from COVID-19 Pneumonitis

A 39-year-old man presented with severe COVID-19 pneumonitis requiring hospital admission. He represented three days following discharge with sudden onset breathlessness and chest pain. Initial imaging suggested the presence of a left pneumothorax. Following further clinical decline a plan was made to insert a CT guided chest drain. However, imaging in the prone position for the procedure unexpectedly revealed a large left lower lobe pneumatocele with only a very small pneumothorax. Events and appearances suggest that this is a rare case of delayed COVID-19 pneumonitis-related pneumatocele formation. We will discuss the clinical significance of this entity. LEARNING POINTS: Pneumatocele formation should be considered in patients presenting with new respiratory symptoms after completing therapy for COVID-19 pneumonitis. Performing CT examinations with patients in different positions may be required to help exclude the possibility of pneumatocele formation when a loculated pneumothorax is suspected on the supine CT images.