Pulmonary cavitation; an under-recognized late complication of severe COVID-19 lung disease

Background: Radiological findings of the novel coronavirus disease 2019 (COVID-19) pulmonary disease have been well documented and range from scattered ground-glass infiltrates in milder cases to confluent ground-glass change, dense consolidation, and crazy paving in the critically ill, however, lung cavitation has not been described in these patients. Objectives: To assess the incidence of pulmonary cavitation and describe its characteristics and evolution. Methods: A retrospective review of all patients admitted to our institution with COVID-19 was undertaken and imaging reviewed to identify patients who developed pulmonary cavitation. Results: Twelve out of 689 (1.7%) patients admitted to our institution with COVID-19 developed pulmonary cavitation, comprising 3.3% (n=12/359) of those with COVID-19 pneumonia, and 11% (n=12/110) of those admitted to the intensive care unit. We describe the imaging characteristics of the cavitation and present the clinical, pharmacological, laboratory, and microbiological parameters for these patients. In this cohort six patients have died while another remains critically ill and unlikely to survive. Conclusion: Cavitary lung disease in patients with severe COVID-19 disease is not uncommon, and is associated with a high level of morbidity and mortality.