Paraseptal Lucencies Mimicking Emphysema in a Non-smoker With Acute Lung Injury in COVID-19

Paraseptal emphysema can be smoking-related but has other causes, including surfactant deficiency, COVID-19, and age. The typical acute chest tomographic findings of COVID-19 include bilateral ground-glass opacities with or without consolidation and interstitial thickening in a peripheral and posterior predominant distribution. Evolution of these findings can occur and ultimately lead to fibrosis. The development of bullae, pneumomediastinum, and pneumothorax can occur as complications of non-invasive or mechanical ventilation. This case report describes incidental paraseptal lucencies that mimicked paraseptal emphysema in a patient with acute hypoxemic respiratory failure secondary to COVID-19 without a prior history of smoking only requiring a high-flow nasal cannula.