CRA15 SPONTANEOUS PNEUMOMEDIASTINUM: AN UNUSUAL PRESENTATION OF INFLUENZA A PNEUMONIA
Tze Liang Lee1, Kah Kian Chong1
1Department of Internal Medicine, Hospital Port Dickson, Port Dickson, Malaysia
Introduction
Influenza can potentially cause acute respiratory distress syndrome (ARDS). This can be potentially fatal, especially in patients with mechanical ventilators. There is also a high incidence of pneumothorax. However, a spontaneous development of hydropneumothorax in patients with Influenza A pneumonia is uncommon.
Objective
To report a case of Influenza A pneumonia-induced spontaneous massive hydropneumothorax.
Case Description
A 74-year-old lady, a known case with hypertension and end-stage renal failure, presented with shortness of breath for three days, associated with fever and cough for one week. Her inflammatory markers were raised, and QiaStat Rapid Test showed Influenza A positive. Echocardiogram revealed poor left ventricular ejection fraction with moderate mitral regurgitation. She required intensive ventilation for two weeks and completed steroid therapy for one week prior to discharge. However, she re-visited one week later with a persistent cough and shortness of breath, and her chest X-ray (CXR) revealed new changes of pneumomediastinum. Otherwise, her inflammatory markers were normal. Due to difficulty in weaning off oxygenation, CT Thorax was arranged, which showed a large left hydropneumothorax with a crazy-paving appearance of both lungs. In view of her advancing age, co-morbidities, and bilateral lung involvement, a decision was made to treat her conservatively. She was subsequently discharged well, and repeated CXR showed resolution of the hydropneumothorax.
Conclusion
High-pressure mechanical ventilation during the management of Influenza A pneumonia with a background of opportunistic infection could be the reason for the spontaneous development of pneumothorax. Hence, it is crucial to recognize the potential consequences of high-pressure mechanical ventilation. It may be reasonable to consider alternative ventilation strategies that could mitigate these risks and promote better patient outcomes.