PMC8716636_01
Contrasted CT scan reveals bilateral lung disease, characterized by: (A) Bilateral pneumothoraces (magenta, red, and green arrows). (B) Interstitial, diffuse infiltrates (blue arrows). (C) Isolated areas of consolidation (orange and yellow arrows). (D) Left lung pneumothorax has its largest prominence in the inferior costophrenic sulcus (red arrows).
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F1
On the fourth day of admission, the patient had worsening dyspnea prompting repeat chest x-ray, which revealed bilateral 20% apical pneumothoraces without tension (Figure 1). CT and CTA was performed to rule out another etiology, such as a pulmonary embolism (PE). CT confirmed the presence of a left pneumothorax with 10% of hemithorax volume in size mostly in the inferior costophrenic sulcus and PE was ruled out (Figure 1).
Admission Timeline of a 60-year-old Black male with a past medical history of HIV infection with a CD4 T cell count of 351 cells/mm3 on HAART, HIV encephalopathy, hyperthyroidism, BMI 18.2 kg/m2, and no active smoking or respiratory disease presented to the hospital due to worsening confusion, cough, and generalized weakness, diagnosed with COVID-19 pneumonia and bilateral pneumothoraces.
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F2
His respiratory status continued to decline with worsening tachypnea and he was transferred to the intensive care unit with oxygen therapy via non-rebreather mask at a flow rate of 12 L/min (Figure 2).