Cardio pulmonary disease

A patient operated for mitral valve replacement for severe mitral stenosis with clot in left atrium. On post op day 10 patient developed respiratory distress. The sequential chest x ray pre and post op with pre op HRCT attached for discussion. He was having preoperative right lung hydropneumothorax for which we put water seal drain one drain one day before on right side. The patient doesnot have tuberculosis so what could be the other disease he may have.

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Could be Ruptured abscess /bulla causing rt Hydropneumothorax. Subcutaneous emphysema with contralateral extension noted. In 1st Cxray misplaced ICD seen. In other cxray properly placed ICD , mitral valve prosthesis,and sternal sutures seen.

Could be post operative D/d pneumonitis Could be covid19