Multiple rib fractures, pleural effusion and right-sided diaphragmatic herniation of the colon into the chest associated with chronic cough after COVID-19

Authors

• Sanjana Chetana Shanmukhappa Rochester Regional Health/Unity Hospital, Rochester, New York, USA
• Muhammad Ahmed Malik Rochester Regional Health/Unity Hospital, Rochester, New York, USA
• Navya Akula University Hospitals/Case Western Reserve University/Harrington Heart and Vascular Institute, Cleveland, Ohio, USA
• Fahd Shaukat Rochester Regional Health/Unity Hospital, Rochester, New York, USA

sanjana.chetanashanmukhappa@rochesterregional.org

Keywords

Abstract

Rib fractures are an infrequent consequence of severe cough. In some patients, undetected rib fractures can lead to life-threatening outcomes. The case of a 73-year-old man who presented with shortness of breath and a worsening dry cough from a SARS-CoV-2 infection for 4 weeks is described. In the emergency department, he was found to be hypoxic and hypotensive. Imaging studies revealed a large right pleural effusion, multiple rib fractures, and right-sided herniation of the colon into the chest. He was admitted to the cardiothoracic intensive care unit where he underwent a flexible bronchoscopy, right video-assisted thoracoscopic surgery, evacuation of a haemothorax, complete decortication, and repair of a diaphragmatic hernia. This case is an unusual presentation of an amalgamation of rare complications resulting from an unrelenting, poorly controlled SARS-CoV-2 infection cough that prompted rapid recognition and swift action.