Anesthesiology Resident

65 yo male. He’s been in ICU for 18 days now. COVID-19 clinically confirmed, negative PCR. On day 7th he presents a pulmonary embolism of the right main pulmonary artery and other lobar arteries. He’s started on anticoagulation. On day 15th subcutaneous emphysema starts to show up and the patient, which was clinically improving and on pressure support with an inspiratory pressure of 10, starts to demand a higher inspiratory pressure to be properly oxygenated. Brownish sputum is now being reported by ICU nurses. Lab results remain fairly normal with a slight increase of PCR from 1 to 3. D dimers going up. We finally decide to transport him to CT and these are the fingings: -extensive pulmonary ground glass opacities with crazy paving pattern -large cavern with possible empyema inside (water level and located where the old embolism occurred) -probable bronchopleural fistula -subcutaneous emphysema -probable #empyemanecessitans #crazy-paving #covid-19 #ct #coronavirus #groundglass