Mehmet Akif EKİCİ, Oğuzhan TURAN, Bayram METİN, İbrahim Ethem ÖZSOY, Mehmet Akif TEZCAN

Spontan Pnömotoraks COVID-19 Bi̇rli̇kteliği

Amaç: Pnömotoraks; viseral ve paryetal plevra katmanları arasında serbest hava olmasıdır. Primer spontan pnömotoraks daha çok gençlerde görülürken; sekonder spontan pnömotoraks daha çok yaşlı (yaş>55) nüfusta gözlenir. Pnömotoraks tedavisinde hedef plevral boşlukta bulunan havanın çıkarılması ve tekrar pnömotoraks oluşmamasıdır. Yeni korona virüs hastalığı 2019’un (COVID-19) akciğerde yarattığı etkiler nedeniyle spontan pnömotoraks riskini arttırması beklenir. COVID-19 ile ilişkili bildirilen pnömotoraks vakalarının çoğunda geleneksel risk faktörleri veya altta yatan predispozan akciğer hastalığı yoktur. Bu çalışmanın amacı; COVID-19 un spontan pnömotoraks ile ilişkisini değerlendirmek ve sonraki çalışmalara ışık tutmaktır. Gereç ve Yöntemler: 12 Mart 2017 ile 12 Mart 2023 tarihleri arasında Kayseri Şehir Hastanesi ne başvuran Spontan Pnömotoraks tanısı alan hastalar retrospektif olarak medikal hastane kayıtları üzerinden tarandı. Hastalar yaş, cinsiyet, primer ve sekonder pnömotoraks olması, sigara içimi, vücut kitle indeksi (VKİ), uygulanan tedavi, hastanede kalış süresi, COVID-19 PCR pozitifliği, nüks kriterleri üzerinden değerlendirildi. COVID-19 öncesi ve sonrası bu kriterler üzerinden karşılaştırıldı. Bulgular: COVID-19 öncesi başvuran 160 hasta, COVID-19 sonrası başvuran 138 hasta tespit edildi. COVID-19 öncesi başvuran hastaların 140’ı (%87) erkek, 20’si (%13) kadındı. COVID-19 sonrası başvuran 138 hastanın 124’ü (%89) erkek, 14’ü (%11) ise kadındı. Hastaların yaş ortalamalarına bakıldığında COVID-19 öncesi yaş ortalaması 25, COVID-19 sonrası ise 28 idi. COVID-19 öncesi başvuran 160 hastanın 111’i (%69) primer spontan pnömotoraks, 49’u (%31) ise sekonder spontan pnömotoraks olarak bulundu. COVID-19 sonrası ise 138 hastanın 108’i (%78) primer spontan pnömotoraks, 30’u (%22) sekonder spontan pnömotoraks idi. Sonuç: Sonuç olarak COVID-19 akciğerlerde kronik inflamasyon ve fibrozisin yanı sıra bül ve bleb oluşumu nedeniyle de spontan pnömotoraks riskini arttırmaktadır. COVID-19 ve spontan pnömotoraks patofizyolojisi net aydınlatılamamıştır. Bu çalışma bu alanda daha sonra yapılacak çalışmalara önayak olacaktır.

Anahtar Kelimeler:

Spontan pnömotoraks, COVİD-19, VATS, Plöredezis

Spontaneous Pneumothorax Coexistence with COVID-19

Aim: The aim of this study is to evaluate the relationship between COVID-19 and spontaneous pneumothorax and shed light on future research. Pneumothorax is the presence of free air between the visceral and parietal pleural layers. Primary spontaneous pneumothorax is more common in young individuals, while secondary spontaneous pneumothorax is more prevalent in the elderly population (age > 55). The treatment goal for pneumothorax is to remove the air in the pleural space and prevent its recurrence. Due to the effects of the novel coronavirus disease 2019 (COVID-19) on the lungs, an increased risk of spontaneous pneumothorax is expected. In most reported cases of pneumothorax associated with COVID-19, there are no traditional risk factors or underlying predisposing lung diseases. Material and Methods: Patients who applied to Kayseri City Hospital with the diagnosis of spontaneous pneumothorax between March 12, 2017 and March 12, 2023 were retrospectively examined through hospital records. Patients were assessed based on age, gender, primary and secondary pneumothorax status, smoking history, body mass index (BMI), administered treatments, length of hospital stay, COVID-19 PCR positivity, and recurrence criteria. These criteria were compared before and after COVID-19. Results: A total of 160 patients presented before COVID-19, while 138 patients presented after COVID-19. Among the patients who presented before COVID-19, 140 (87%) were male, and 20 (13%) were female. Among the 138 patients who presented after COVID-19, 124 (89%) were male, and 14 (11%) were female. When looking at the average ages of the patients, the pre-COVID-19 average age was 25, while the post-COVID-19 average age was 28. Out of the 160 patients who presented before COVID-19, 111 (69%) had primary spontaneous pneumothorax, and 49 (31%) had secondary spontaneous pneumothorax. After COVID-19, out of the 138 patients, 108 (78%) had primary spontaneous pneumothorax, and 30 (22%) had secondary spontaneous pneumothorax. Conclusion: In conclusion, COVID-19 increases the risk of spontaneous pneumothorax not only due to chronic inflammation and fibrosis in the lungs but also because of bullae and bleb formation. The pathophysiology of COVID-19 and spontaneous pneumothorax remains unclear. This study will pave the way for further research in this field.

Keywords:

Spontaneous pneumothorax, COVID-19, VATS (Video-Assisted Thoracoscopic Surgery), pleurodesis,

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