Management of Pneumothorax Secondary to COVID-19 – Experience of Fourteen Cases

Background: Pneumothorax is an uncommon but potentially fatal complication of coronavirus disease 2019 (COVID-19), particularly in patients with severe lung damage. Bronchopleural fistula (BPF) and persistent air leaks further complicate management. Objective: This study describes the clinical features, management strategies, and outcomes of patients with pneumothorax secondary to COVID-19. Methodology: A prospective observational study was conducted at Ayub Teaching Hospital, Abbottabad, from 2019 to 2022. Fourteen patients with confirmed COVID-19 who developed pneumothorax were included. Data were retrieved from clinical records and radiology. Variables analyzed included demographics, comorbidities, type of pneumothorax, management interventions, and outcomes. The primary outcome was survival and resolution of pneumothorax; secondary outcomes included need for pleurodesis, application of suction, and complications. Results: Of the 14 patients, 10 (71.4%) were male and 4 (28.6%) female, with a mean age of 55 years. Four patients (28.6%) had COPD as a comorbidity. Unilateral pneumothorax occurred in 12 patients (85.7%), while 2 (14.3%) had bilateral involvement. All patients underwent chest tube drainage; 10 (71.4%) required low-pressure suction, and pleurodesis was performed in 10 (71.4%) cases. No surgical or endobronchial interventions were performed. Recovery was achieved in 10 patients (71.4%), while 4 (28.6%) died, mostly due to severe COVID-19 pneumonia and associated comorbidities. Conclusion: Pneumothorax in COVID-19 is a serious complication requiring prolonged management. Chest tube drainage is the mainstay of treatment, often supplemented by suction or pleurodesis. Early recognition and individualized strategies are essential to improve outcomes.