Figure 1b. Chest X-ray showing bilateral lung opacities (before pneumothorax)
The patient was managed with a non-rebreather face mask with an oxygen flow rate of 15 L/minute, and a chest tube was inserted at the fourth intercostal space to drain the pneumothorax. Despite those measures, he deteriorated, for which an HRCT chest was ordered. HRCT scan (Figure 2a, Figure 2b.) revealed a right hydropneumothorax with passive right lung atelectasis and an intermediate walled cavity in the right lower lobe with bronchopleural fistula. Also, multifocal ground glass consolidations were seen predominantly in bilateral peripheral lung fields with fibro-bronchiectatic changes with crazy pavement patterns suggesting sequelae of COVID-19 pneumonia.