Posters
Academic Level (Author 1)
Medical Student
Discipline/Specialty (Author 1)
Pediatrics
Discipline Track
Patient Care
Abstract
Background: As cases of Covid-19 continue to rise, more population subtypes become at risk. Although rare in past years, COVID-19 is becoming more prevalent in children. Last counts obtained show that there are 8,992 cases per 100,000 in children, state hospitalizations rates ranging from 1.7%- 4.0% of their total cumulated hospitalizations with 0.1%-1.9% of all their pediatric COVID-19 cases resulting in hospitalization. As these cases rise, we are still unsure of the immediate or long-term effects in children, and continual observation and documentation of all clinical courses is of the utmost importance. Here, we present an interesting case of a young adolescent male with autism, which has shown to have a connection with abnormal lung architecture, who was diagnosed with COVID-19, followed by pneumothorax, complicated by bullae formation, and producing a vastly complex case not previously reported in the literature.
Case Presentations: A 13-year-old autistic male presented hypoxemic and tachypneic to the children’s hospital. History of present illness showed a 4-day history of cough and increasing dyspnea, requiring oxygen at 4 liters/minute at the hospital to maintain appropriate saturations. He subsequently tested positive for COVID-19, requiring treatment with Remdesivir, ceftriaxone, albuterol, and 3% hypertonic saline during his 8-day hospital stay. 15 days after discharge, the child presented back to the children’s hospital with persistent coughing and sharp left inferior-lateral chest pain, with chest x-ray’s displaying multifocal pneumonia and a small left-sided pneumothorax which was treated conservatively. The pain however was not alleviated, and additional imaging with CT showed several bullae, with the largest measuring 7cm x 6cm. This largest bulla was compressing the left diaphragm. Persistent coughing eventually led to the patient experiencing a tension pneumothorax, sending him to the PICU for chest tube placement, which removed over 200mL of air. Follow up Xray showed resolution of the pneumothorax, however the left diaphragm was elevated, and fluoroscopy demonstrated a paralyzed, non-functioning diaphragm. The patient was treated and able to be discharged 8 days later.
Discussion & Conclusions: This case displays the drastic effects that can be caused by COVID-19 in the pediatric population. Although children have not been shown to display the same symptoms clinically as adults, we aim to show the urgency and importance of information collection and implementation of standards of care in this population. This case addresses two main issues: the importance of thorough analysis of patients with a comprehensive history, physical, and imaging, as shown here the paralyzed diaphragm and bullae could have potentially been missed leading to further drastic outcomes. Additionally, understanding the compounding effects that genetics may play in the clinical course of children who acquire COVID-19. Anatomic defects connected with autism could have been exacerbated with the COVID-19 diagnosis and played a large part in the formation of this patient’s pneumothorax, bullae, and diaphragm paralysis.
Presentation Type
Poster
Recommended Citation
Bigham, Dakota and Stewart, Barbara, "Case Report: COVID-19 Pneumothorax" (2023). Research Colloquium. 11.
https://scholarworks.utrgv.edu/colloquium/2022/posters/11
Included in
Case Report: COVID-19 Pneumothorax
Background: As cases of Covid-19 continue to rise, more population subtypes become at risk. Although rare in past years, COVID-19 is becoming more prevalent in children. Last counts obtained show that there are 8,992 cases per 100,000 in children, state hospitalizations rates ranging from 1.7%- 4.0% of their total cumulated hospitalizations with 0.1%-1.9% of all their pediatric COVID-19 cases resulting in hospitalization. As these cases rise, we are still unsure of the immediate or long-term effects in children, and continual observation and documentation of all clinical courses is of the utmost importance. Here, we present an interesting case of a young adolescent male with autism, which has shown to have a connection with abnormal lung architecture, who was diagnosed with COVID-19, followed by pneumothorax, complicated by bullae formation, and producing a vastly complex case not previously reported in the literature.
Case Presentations: A 13-year-old autistic male presented hypoxemic and tachypneic to the children’s hospital. History of present illness showed a 4-day history of cough and increasing dyspnea, requiring oxygen at 4 liters/minute at the hospital to maintain appropriate saturations. He subsequently tested positive for COVID-19, requiring treatment with Remdesivir, ceftriaxone, albuterol, and 3% hypertonic saline during his 8-day hospital stay. 15 days after discharge, the child presented back to the children’s hospital with persistent coughing and sharp left inferior-lateral chest pain, with chest x-ray’s displaying multifocal pneumonia and a small left-sided pneumothorax which was treated conservatively. The pain however was not alleviated, and additional imaging with CT showed several bullae, with the largest measuring 7cm x 6cm. This largest bulla was compressing the left diaphragm. Persistent coughing eventually led to the patient experiencing a tension pneumothorax, sending him to the PICU for chest tube placement, which removed over 200mL of air. Follow up Xray showed resolution of the pneumothorax, however the left diaphragm was elevated, and fluoroscopy demonstrated a paralyzed, non-functioning diaphragm. The patient was treated and able to be discharged 8 days later.
Discussion & Conclusions: This case displays the drastic effects that can be caused by COVID-19 in the pediatric population. Although children have not been shown to display the same symptoms clinically as adults, we aim to show the urgency and importance of information collection and implementation of standards of care in this population. This case addresses two main issues: the importance of thorough analysis of patients with a comprehensive history, physical, and imaging, as shown here the paralyzed diaphragm and bullae could have potentially been missed leading to further drastic outcomes. Additionally, understanding the compounding effects that genetics may play in the clinical course of children who acquire COVID-19. Anatomic defects connected with autism could have been exacerbated with the COVID-19 diagnosis and played a large part in the formation of this patient’s pneumothorax, bullae, and diaphragm paralysis.