COVID-19, Chronic Obstructive Pulmonary Disease and Pneumoth
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Acute respiratory distress syndrome (ARDS) is the most common complication of COVID-19, and the main cause of death.

This report presents the case of an 87-year-old male patient who was admitted to the emergency department during the COVID-19 epidemic, with a 6-day history of worsening dyspnoea without cough or fever. He was a heavy smoker. He had never undergone pulmonary[Q2] evaluation. He was taking low-dose aspirin for primary prevention of cardiovascular disease, as prescribed by his general practitioner.

At admission the patient denied previous contact with any individual positive for SARS-CoV-2. He was tachypnoeic and dyspnoeic. Arterial blood gas (ABG) analysis, blood tests and nasopharyngeal swabs for 2019-nCoV, an electrocardiogram and point-of-care lung ultrasound (LUS) were carried out. ABG analysis showed severe hypoxaemia with compensated metabolic acidosis. EKG showed sinus tachycardia. Blood tests demonstrated lymphocytopenia, increased C-reactive protein, creatinine and urea with normal serum electrolytes, lactate dehydrogenase, liver function and coagulation times.

High-resolution chest CT scan (HRCT) confirmed the diagnosis of left pneumothorax and revealed diffuse emphysema, as observed in COPD, and small consolidations in both lower lobes, suggestive of COVID-19 pneumonia. A chest tube for drainage was immediately inserted in the emergency room with complete resolution of the dyspnoea and pneumothorax on chest x-ray.

The patient was diagnosed with atraumatic pneumothorax and COPD related to suspected COVID-19 pneumonia. A nasopharyngeal swab for 2019-nCoV was positive, The patient refused all therapeutic options, including intubation. The chest drain was removed with no further recurrence. The patient died 48 days after admission from COVID-19-related ARDS.