Spontaneous tension pneumothorax and acute pulmonary emboli in a patient with COVID-19 infection

BMJ Case Rep. 2020 Aug 11;13(8):e237475. doi: 10.1136/bcr-2020-237475.


The COVID-19 pandemic has had a significant impact on the structure and operation of healthcare services worldwide. We highlight a case of a 64-year-old man who presented to the emergency department with acute dyspnoea on a background of a 2-week history of fever, dry cough and shortness of breath. On initial assessment the patient was hypoxic (arterial oxygen saturation (SaO2) of 86% on room air), requiring 10 L/min of oxygen to maintain 98% SaO2 Examination demonstrated left-sided tracheal deviation and absent breath sounds in the right lung field on auscultation. A chest radiograph revealed a large right-sided tension pneumothorax which was treated with needle thoracocentesis and a definitive chest drain. A CT pulmonary angiogram demonstrated segmental left lower lobe acute pulmonary emboli, significant generalised COVID-19 parenchymal features, surgical emphysema and an iatrogenic pneumatocoele. This case emphasises the importance of considering coexisting alternative diagnoses in patients who present with suspected COVID-19.

Keywords: pneumothorax; pulmonary embolism; radiology; respiratory medicine; tropical medicine (infectious disease).

Publication types

  • Case Reports

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Anticoagulants / therapeutic use
  • Betacoronavirus / isolation & purification*
  • COVID-19
  • Coronavirus Infections / complications*
  • Coronavirus Infections / diagnosis
  • Coronavirus Infections / therapy
  • Drainage
  • Humans
  • Lung / diagnostic imaging
  • Male
  • Middle Aged
  • Oxygen Inhalation Therapy
  • Pandemics
  • Pneumonia, Viral / complications*
  • Pneumonia, Viral / diagnosis
  • Pneumonia, Viral / therapy
  • Pneumothorax / complications*
  • Pneumothorax / diagnostic imaging
  • Pneumothorax / therapy
  • Pulmonary Embolism / complications*
  • Pulmonary Embolism / diagnostic imaging
  • Pulmonary Embolism / drug therapy
  • Radiography, Thoracic
  • SARS-CoV-2
  • Tinzaparin / therapeutic use
  • Tomography, X-Ray Computed


  • Anti-Bacterial Agents
  • Anticoagulants
  • Tinzaparin