SHM Converge Scientific Abstract ePoster Gallery-Clot or Not: Pulmonary Infarct Following Covid-19 Infection

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This case report describes a previously healthy 5-year-old girl who developed an unusual pulmonary complication after COVID-19 infection. She initially presented with cough and respiratory distress, and imaging was interpreted as right upper lobe pneumonia with small bilateral pleural effusions. She improved with antibiotics and was discharged, but 25 days later follow-up imaging revealed a right hydropneumothorax despite resolution of symptoms.<br /><br />After readmission, she was found to have blood and air in the right pleural space. A chest catheter and chest tube were placed, and later she required video-assisted thoracoscopic surgery (VATS) with adhesiolysis because of worsening pneumothorax and chest tube malfunction. During surgery, necrotic lung tissue was removed, and she was diagnosed with post-COVID necrotizing pneumonitis.<br /><br />On re-evaluation of the initial chest x-ray, the original “consolidation” was thought to be more consistent with a wedge-shaped pulmonary infarct rather than bacterial pneumonia, suggesting COVID-related microthrombotic disease as the underlying process. The authors emphasize that although most children experience mild COVID-19, some can develop serious sequelae such as pulmonary infarction, hemopneumothorax, and necrotizing lung injury.<br /><br />The case highlights the importance of considering thrombotic complications in pediatric COVID-19, especially when imaging findings are atypical or when clinical improvement does not match radiographic progression. The authors conclude that COVID-19–associated hypercoagulability can be life-threatening even in children and may warrant ongoing attention to prophylactic anticoagulation strategies and careful follow-up.

Asset Subtitle

Caroline Cwalina

Meta Tag

Author List Amber Vozar, Caroline Cwalina, Casandra Arevalo Marcano, David Thomas, Morgan Decker, Saif Al Qatarneh

Category Clinical Vignettes

Concept COVID-19

Concept Pulmonary Complication

Concept Pulmonary infarction

Concept Pediatric Patient

Concept Hypercoagulable State

Distinguished Non-Finalist

Presenter Organization WVU Medicine

Presenting Author Caroline Cwalina

Track Pediatric

Keywords

COVID-19

pediatric case report

pulmonary infarction

hemopneumothorax

necrotizing pneumonitis

hydropneumothorax

microthrombotic disease

thoracoscopic surgery

pleural effusion

hypercoagulability

COVID-19

Pulmonary Complication

Pulmonary infarction

Pediatric Patient

Hypercoagulable State