Okusanya, Olugbenga

Sultan, Ibrahim

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Thomas Jefferson University Jefferson Digital Commons Department of Surgery Faculty Papers Department of Surgery 12-1-2020 Commentary: Coronavirus, cysts, and catheters Olugbenga Okusanya Ibrahim Sultan Follow this and additional works at: https://jdc.jefferson.edu/surgeryfp  Part of the Surgery Commons Let us know how access to this document benefits you This Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of Thomas Jefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarly publications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers and interested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion in Department of Surgery Faculty Papers by an authorized administrator of the Jefferson Digital Commons. For more information, please contact: JeffersonDigitalCommons@jefferson.edu. See Article page 353.Commentary: Coronavirus, cysts,and cathetersOlugbenga Okusanya, MD,a andIbrahim Sultan, MDb,cThe emergency of the novel virus severe acute respiratorysyndrome coronavirus 2 (coronavirus disease 2019[COVID-19]) has changed the global health landscape. Firstdetected in China at the end of 2019, the virus rapidlyspread to every developed and undeveloped country in theworld.1 Currently, more than 24 million people have beeninfected, with more than 800,000 deaths.2 The diseaseprimary manifests as a respiratory illness, but a myriad ofother organ systems, including the cardiovascular,neurologic, and musculoskeletal systems, are known to beinvolved.3 Respiratory disease can range from asymptom-atic and mild to severe requiring mechanical support,extracorporeal membrane oxygenation, or even lungtransplantation.4 Currently, the most common finding onimaging is diffuse bilateral ground-glass opacities.Brahmbhatt and colleagues5 in their case report describea patient with severe acute respiratory syndrome coronavi-rus 2 infection who developed bilateral cystic lung changes.These changes were not found in the patient beforeinfection and appear to have resolved with time andpercutaneous computed tomography–guided drainage.The patient, who had significant comorbidities, presentedand was managed with escalating noninvasive oxygenationstrategies but developed a left pneumatocele and right-sidedcyst. Drainage showed an exudative fluid analysis withoutbacterial growth. The patient recovered and was discharged.There a few scattered reports of COVID-19–relatedcystic change, with some showing superinfection.6However, with the absence of a secondary infection orbarotrauma, it is believed that the acute respiratory distresssyndrome related to the lung infection is sufficient tocause these lung changes. Drainage of these collectionsis somewhat controversial. Cystic lung changes orpneumatoceles during the course of other pulmonaryinfections are usually managed without intervention andresolve with time.7 However, these lesions if infected orsymptomatic require drainage or surgical therapy. Inpatients who are critically ill with COVID-19,superinfection is believed to be common; thus, given this,some may advocate early drainage of discrete lesionsamenable to safe percutaneous access.As COVID-19 continues to spread and potentiallyreinfect patients, we must all broaden our knowledge baseand clinical expertise in treating these patients. It is criticalthat any significant sequelae of this disease are recognizedand best efforts are made to develop expert managementstrategies.References1. Guan WJ, Ni ZY, Hu Y, Liang W, Ou C, He J, et al. Clinical characteristics ofcoronavirus disease 2019 in China. N Engl J Med. 2020;382:1708-20.2. Johns Hopkins University. COVID-19 Dashboard. Available at: https://coronavirus.jhu.edu/map.html. Accessed August 26, 2020.3. Stawicki SP, Jeanmonod R, Miller AC, Paladino L, Gaieski DF, Yaffee AQ,et al. The 2019-2020 novel coronavirus (severe acute respiratory syndromecoronavirus 2) pandemic: a Joint American College of Academic InternationalMedicine-World Academic Council of Emergency Medicine Multidisci-plinary COVID-19 working group consensus paper. J Glob Infect Dis. 2020;12:47-93.4. Sultan I, Habertheuer A, Usman AA, Kilic A, Gnall E, Friscia ME, et al. The roleof extracorporeal life support for patients with COVID-19: preliminary resultsfrom a statewide experience. J Card Surg. 2020;35:1410-3.5. Brahmbhatt N, Tamimi O, Ellison H, Katta S, Youssef J, Cortes C, et al.Pneumatocele and cysts in a patient with severe acute respiratory syndromecoronavirus 2 infection. J Thorac Cardiovasc Surg Tech. 2020;4:353-5.From the aDepartment of Surgery, Thomas Jefferson University Hospital,Philadelphia; bDepartment of Cardiothoracic Surgery, University of PittsburghSchool of Medicine, Pittsburgh; and cHeart and Vascular Institute, University ofPittsburgh Medical Center, Pittsburgh, Pa.Disclosures: The authors’ institution receives research support from Medtronic andAtriCure. These are not related to this work. The authors reported no conflicts ofinterest.The Journal policy requires editors and reviewers to disclose conflicts of interest andto decline handling or reviewing manuscripts for which they may have a conflict ofinterest. The editors and reviewers of this article have no conflicts of interest.Received for publication Sept 3, 2020; revisions received Sept 3, 2020; accepted forpublication Sept 24, 2020; available ahead of print Sept 28, 2020.Address for reprints: Ibrahim Sultan, MD, Division of Cardiac Surgery, 5200 CentreAve, Suite 715, Pittsburgh, PA 15232 (E-mail: sultani@upmc.edu).JTCVS Techniques 2020;4:356-72666-2507Copyright 2020 TheAuthors. Published by Elsevier Inc. on behalf of The AmericanAssociation for Thoracic Surgery. This is an open access article under the CCBY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).https://doi.org/10.1016/j.xjtc.2020.09.034Olugbenga Okusanya, MD, and Ibrahim Sultan, MDCENTRAL MESSAGELung parenchymal changesassociated with COVID-19 mayinclude cystic changes.356 JTCVS Techniques c December 2020Commentary Okusanya and Sultan6. Castiglioni M, Pelosi G, Meroni A, Tagliabue M, Uslenghi E, Salaris D, et al.Surgical resections of superinfected pneumatoceles in a COVID-19 patient. AnnThorac Surg. June 27, 2020 [Epub ahead of print].7. Kaira K, Ishizuka T, Yanagitani N, Sunaga N, Hisada T, Mori M.Pulmonary traumatic pneumatocele and hematoma. Jpn J Radiol. 2009;27:100-2.JTCVS Techniques c Volume 4, Number C 357Okusanya and Sultan Commentary

Commentary: Coronavirus, cysts, and catheters

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