Pleural empyema associated with COVID-19 pneumonia

• Karpickij A.S.
• Pan’ko E.S.
• Vakulich D.S.
• Zhurbenko G.A.
• Pan’ko S.V.
• Shestiuk A.M.

Abstract

Background. The lungs are the main target organ for the SARS-Cov-2 virus, which causes the development of pneumonia, often accompanied with hydrothorax and very rarely with pleural empyema, so there are no guidelines for the management of parapneumonic purulent complications.

Aim of the study was to present the variability in the clinical course, treatment and outcome of pleural empyema in the acute phase of COVID-19.

Material and method. Our case report and previously reported cases of pleural empyema in patients with COVID-19 identified through Google Scholar were presented/described and retrospectively summarized.

Results. Twelve cases were selected detailing the management of pleural empyema in the acute phase of COVID-19. Risk factors included male sex, age over fifty years, diabetes mellitus, chronic heart failure, obesity, and other factors that could cause immunodeficiency. X-ray examination was used to assess the severity of parenchymal lung lesions and parapneumonic pathology, as well as functional indicators of oxygenation and ventilation to assess the severity of hypoxemic respiratory failure in these patients. Markers of the severity of the parapneumonic process were changes in blood counts and the specificity of microflora in the pleural fluid. CT-guided drainage of empyema was used in four patients with relatively compensated hypoxia. However, this method led to respiratory failure and death of the patient with bronchopleural fistula. Thoracotomy with decortication, pleurectomy and resection of the pulmon ary parenchyma were effective in three patients with severe hypoxemic respiratory failure. However, in a patient with a bronchopleural fistula and severe immunodeficiency, open resection of the lung tissue was lethal. The effectiveness of bronchoscopic broncho-occlusion and drainage of empyema with bronchopleural fistulas has also been described. Video-assisted thoracoscopic debridement was effective in our and previous case reports for the treatment of parapneumonic empyema associated with Covid-19 in the acute phase of the infectious process.

Conclusion. We believe that early diagnosis, drainage and debridement of the pyothorax cavity using minimally invasive approaches and control of hypoxic respiratory failure associated with SARS-CoV-2 at all stages of patient management are the cornerstones of successful treatment of parapneumonic empyema in the acute phase of COVID-19.

Keywords: COVID-19; pneumonia; pleural empyema; VATS

References

1.     Zarubin E.A., Kogan E.A., Zharkov N.V., Avdalyan A.M., Protsenko D.N. Clinical and morphological analysis of lung lesions with determination of cellular localization of SARS-CoV-2 virus proteins in lethal cases of COVID-19. Klinicheskaya i eksperimental’naya khirurgiya. Zhurnal imeni akademika B.V.  Petrovskogo [Clinical and Experimental Surgery. The Journal named after Academician B.V. Petrovsky]. 2023; 11 (1): 54–63. DOI: https://doi.org/10.33029/2308-1198-2023-11-1-54-63 (in Russian)

2.     Chong W.H., Saha B.K., Conuel E., Chopra A. The incidence of pleural effusion in COVID-19 pneumonia: state-of-the-art review. Heart Lung. 2021; 50 (4): 481–90. DOI: https://doi.org/10.1016/j.hrtlng.2021.02.015

3.     Salimov D.Sh., Glushkov I.V., Vorob’ev A.A., Kraynukov P.E. Pleura damage in COVID-19, experience of treatment during eighteen months of the pandemic. Operativnaya khirurgiya i klinicheskaya anatomiya (Pirogovsky nauchniy zhurnal) [Operative Surgery and Clinical Anatomy (Pirogov Scientific Journal)]. 2022; 6 (2): 26–31. DOI: https://doi.org/10.17116/operhirurg2022602126 (in Russian)

4.     Chong W.H., Huggins J.T., Chopra A. Characteristics of  pleural effusion in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia. Am J Med Sci. 2021; 361 (2): 281–4. DOI: https://doi.org/10.1016/j.amjms.2020.09.008

5.     Silalahi T.D.A., Suwita C.S. Culture-negative pleural empyema after Coronavirus disease-19 resolution – a case report. Respir Med Case Rep. 2021; 34: 101473. DOI: https://doi.org/10.1016/j.rmcr.2021.101473

6.     Ayad S., Gergis K., Elkattawy S., Mirza N., Abdelazeem  B., Patel L., et al. Loculated empyema and SARS-CoV-2 infection: a report of two cases and review of the literature. Eur J Case Rep Intern Med. 2021; 8 (7): 002706. DOI: https://doi.org/10.12890/2021_002706 Epub2021 Jul 15.

7.     Okba F.A., Fahmi H.K., Bnar J.H.A., Berwn A.A., Marwan  N.H., Rawezh Q.S., et al. Post COVID-19 pulmonary complications; a single center experience. Ann Med Surg. 2021; 72: 103052. DOI: https://doi.org/10.1016/j.amsu.2021.103052

8.     Kalenchic T.I., Kabak S.L., Primak S.V., Melnichenko  Y.M., Kudelich O.A. Bilateral parapneumonic pleural effusion with pneumothorax in a patient with covid 19 pneumonia: case report. Radiol Case Rep. 2022; 17 (3): 869–74. DOI: https://doi.org/10.1016/j.radcr.2021.12.039 Epub 2022 Jan 10. PMID: 35035651; PMCID: PMC8743860.

9.     Abbasi R., Javanmardi F.S., Mokhtari A., Hosseinpour  P., Shahriarirad R., Ebrahimi K. Management of pleural empyema in a 12-year-old obese patient with COVID-19: a pediatric case report. BMC Pediatr. 2021; 21 (1): 531. DOI: https://doi.org/10.1186/s12887-021-03007-1 Epub 2021 Nov 30.

10. Tessitore A., Patella M., Giuliani M., Theologou T., Freguia S., Minerva E.M., et al. Surgical treatment of pleural empyema in Coronavirus disease 19 patients: the Southern Switzerland experience. Interact Cardiovasc Thorac Surg. 2021; 32 (3): 367–70. DOI: https://doi.org/10.1093/icvts/ivaa269

11. Karampinis I., Likos-Corbett M., Buderi S. Erfolgreiche Behandlung eines drittgradigen Pleuraempyems infolge einer COVID-19-Infektion [Successful treatment of a stage III pleural empyema following a COVID-19 infection]. Chirurg. 2021; 92 (2): 134–6. DOI: https://doi.org/10.1007/s00104-021-01362-4 Epub 2021 Jan 29. PMID: 33512559; PMCID: PMC7844776. (in  German)

12. Yarlagadda K., Mi K., Sendil S., Koons C.L., Komanduri  S., Cinicola J.T. A 31-year-old man with COVID-19-associated empyema and lupus anticoagulant. Am J Case Rep. 2020; 21: e926623. DOI: https://doi.org/10.12659/AJCR.926623 Epub 2020 Aug 18.

13. Nakano T., Kawada M., Minami K., Kaneda H. Successful endobronchial occlusion in empyema with broncho-pleural fistula secondary to COVID-19 pneumonia: a case report and literature review. Respirol Case Rep. 2021; 9 (7): e00785. DOI: https://doi.org/10.1002/rcr2.785 PMID: 34094570; PMCID: PMC8150524.

14. Panko S., Vakulich D., Karpitski A., Zhurbenka H., Shestiuk A., Boufalik R., et al. Intrathoracic negative pressure therapy and/or endobronchial valve for pleural empyema minimal invasive management: case series of thirteen patients and review of the literature. Videosurg Other Miniinvasive Tech. 2020; 15 (4): 588–95.

15. Malofey A.M., Ablitsov A.Yu., Orlov S.S., Khrupkin V.I., Gallуamov E.A., Romanikhin A.I., et al. Features of the treatment of pleuropulmonary complications of covid-associated pneumonia. Vestnik Natsional’nogo mediko-khirurgicheskogo Tsentra imeni N.I. Pirogova [Bulletin of the National Medical-Surgical Center named after N.I. Pirogov]. 2022; 17 (4-2): 75–80. DOI: https://doi.org/10.25881/20728255_2022_17_4_2_75  
(in Russian)

16. Placik D.A., Taylor W.L., Wnuk N.M. Bronchopleural fistula development in the setting of novel therapies for acute respiratory distress syndrome in SARS-CoV-2 pneumonia. Radiol Case Rep. 2020; 15 (11): 2378–81. DOI: https://doi.org/10.1016/j.radcr.2020.09.026 Epub 2020 Sep 18. PMID: 32983308; PMCID: PMC7500914.

17. Gurung A., Poudel D., Gurung B., Rawal P., Chapagain  S. Fatal pyopneumothorax in a COVID-19 patient. Cureus. 2022; 14 (11): e31866. DOI: https://doi.org/10.7759/cureus.31866 PMID: 36579191; PMCID: PMC9789894.

18. Pan’ko E.S., Zhavoronok S.V., Solovchuk A.M., Pan’ko  S.S., Pan’ko S.V. Predictors of length of hospital stay in patients with acute COVID-19. Zhurnal infektologii [Journal of Infectology]. 2023; 15 (1): 86–92. DOI: https://doi.org/10.22625/2072-6732-2023-15-1-86-92 (in Russian)

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