Characterization of Post COVID‑19 pneumo‑hematocele in the largest COVID-19 center in Mexico City.

BACKGROUND

Surgical management of post-COVID pneumo-hematocele is uncommon, and evidence regarding outcomes and risk factors for complications following video-assisted thoracoscopic surgery (VATS) is limited.

OBJECTIVE

To describe the clinical and surgical outcomes of video-assisted thoracoscopic surgery (VATS) for pneumo-hematocele in patients treated at the largest COVID-19 tertiary care center in Mexico City, and to explore associations between lesion characteristics and postoperative complications.

METHODS

We conducted a retrospective analysis of consecutive hospitalized COVID-19 patients with pneumo-hematocele who underwent VATS between September 2020 and September 2021. Sociodemographic, clinical, radiological, and surgical variables were collected. Exploratory logistic regression analyses with bootstrap validation and Firth penalization were performed to assess associations between lesion size and postoperative complications. A ROC curve analysis was used to identify an exploratory size threshold.

RESULTS

Eighteen male patients were included, with a median age of 37 years (32.8–50.8); 61.1% were active smokers, and 27.8% had a history of mechanical ventilation. Most patients (77.8%) were symptomatic prior to diagnosis, most commonly with dyspnea. Lesions were predominantly unilateral (66.7%) and most frequently involved the right lower lobe. Pneumothorax occurred in 88.9% of cases and was managed preoperatively with pleural drainage. No patient required surgical reintervention. Postoperative air leakage occurred in 33.3% of patients but resolved in less than 72 h in all cases. In exploratory analyses, a lesion diameter ≥ 8.3 mm was associated with increased risk of postoperative air leakage (OR 13.33, 95% CI 1.27–54.00, p = 0.044), with a sensitivity of 83.3% and specificity of 72.7%. The median hospital stay was 4 days (3.0–5.8), and no surgery-related deaths were observed.

CONCLUSIONS

Video-assisted thoracoscopic surgery (VATS) is a safe surgical option for the management of post-COVID-19 pneumo-hematocele. In this exploratory analysis, larger lesion diameter (≥ 8.3 mm) was associated with an increased risk of postoperative air leakage. If validated in larger cohorts, this threshold could help identify patients who may benefit from closer postoperative monitoring or preventive intraoperative measures such as reinforced stapling techniques.