Pleural and Primary Mediastinal Complications and Treatment of COVID-19 Patients

Soleyman Heydari; Mohsen Andisheh; Mohammad Raeeszadeh; Amir Reza Fazeli; Jamal  Akhavan-Moghaddam; Mahdi Morshedi; Maryam Rezaee; Hamed Gholizade

doi:10.18502/ajs.v7i3.17462

Soleyman Heydari Department of Surgery, Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
Mohsen Andisheh Department of Surgery, Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
Mohammad Raeeszadeh Department of Surgery, Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
Amir Reza Fazeli Division of Colorectal Surgery, Department of Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Jamal Akhavan-Moghaddam Department of Surgery, Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
Mahdi Morshedi Department of Surgery, Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
Maryam Rezaee Department of Surgery, Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
Hamed Gholizade Department of Surgery, Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.

DOI: https://doi.org/10.18502/ajs.v7i3.17462

Keywords: COVID-19, Complications, Pleural Effusion

Abstract

The persistent disease 2019 (COVID-19) presents prodigious challenges for research and medical practice, mainly due to its specific epidemiological and clinical characteristics. Patients with COVID-19 pneumonia may have conditions ranging from asymptomatic to death due to respiratory failure. COVID-19 pneumonia may be associated with pleural complications such as pneumothorax (PT), pneumomediastinum (PM), pleural effusion, and empyema. This study investigates primary Pleural and Mediastinal Complications (PPMCs) and their treatment in patients with COVID-19. In this cross-sectional study, 10,000 patients with COVID-19 were investigated for the incidence of mediastinal and pleural effusions between the beginning of the second half of 2019 and the end of the first half of 2020. The average age of patients with PPMCs was 54.29 ± 14.69 years. 62% (124 patients) were male and 38% (76 patients) were female. Among 10,000 patients with COVID-19, 600 patients (6%) had pleural effusion, of which 456 (4.56%) had mild pleural effusion, and 144 (1.44%) had moderate to severe pleural effusion. The frequency of PPMCs in COVID-19 patients was as follows: 0.53% (53 cases) PT, 0.09% (9 cases) hemothorax, 0.06% (6 cases) empyema, 0.96% (96 cases) PM, 0.12% (12 cases) pericardial effusion, 0.17% (17 cases) atelectasis, and 0.04% (4 cases) emphysema. The most frequent pleural complication was pleural effusion, with a frequency of 6%, and the second most common complication was PM, with a prevalence of 0.96%. Being elderly was strongly associated with the rate of intubation and mortality in the hospital (P<0.05). No significant relationship existed between patients’ age and PPMCs (p>0.05). There was no significant difference in PPMCs between men and women (p>0.05). The results of our study show that PPMCs in patients with COVID-19 have a low prevalence, and if they do occur, the most frequent are related to pleural effusion and PM.