A 72-year-old male patient presented with shortness of breath and fever of ten days duration. He was diagnosed with stage IV bronchogenic carcinoma and lymphangitis carcinomatosis five months prior to his presentation. On the initial assessment, he appeared uncomfortable, dyspneic, tachypneic and cachetic. The blood pressure was 140/85 mmHg, heart rate: 124 beats/min, oxygen saturation: 79%, and body temperature: 37.7 Co. Chest expansion was reduced as well as the air entry on the left side of the chest; course crepitation on auscultating the other side.
The chest radiograph showed left sided with multiple right sided chest opacifications demonstrating a massive pleural effusion (Fig. 1). Chest thoracostomy tube was inserted on the left side, draining a clear serous fluid. Fluid sample was sent for cytology, acid fast bacilli culture, biochemistry, and Gram-stain culture and sensitivity. The patient was admitted to the thoracic ward for gradual chest decompression. He was maintained on antibiotics, and analgesia. Due to COVID-19 pandemic, the patient was sent for a CT scan of the chest, and PCR for COVID-19 to look for any evidence of COVID-19. The PCR was obtained from two sites (nasopharyngeal, and oropharyngeal).
Unsurprisingly, the PCR test came back positive for COVID-19. The CT chest showed multiple ground glass opacifications on both lungs, and pleural effusion on the left side with irregular hilar mass (Fig. 2). The patient condition deteriorated; he became dyspneic and his oxygen saturation never exceeded 85% despite oxygen supply on the ward. He was transferred to ICU for ventilatory support. After three days, the result of pleural cytology was negative for metastasis, and AFB was negative for tuberculosis. The patient's condition gradually deteriorated in the following days with elevated renal parameters and progressive hypoxia. On the sixth, the patient unfortunately passed away due to severe hypoxia that led to a cardiac arrest.
CT scan of chest in day two post-intervention, showed multiple ground glass opacifications on both lungs, and pleural effusion on the left side with irregular hilar mass.