Objective The pandemic of coronavirus disease 2019 (COVID-19) has caused devastating morbidity and mortality worldwide. In particular, thromboembolic complications have emerged as a key threat for patients with COVID-19. We assessed our experience with deep vein thrombosis (DVT) in patients with COVID-19. Methods We performed a retrospective analysis of all patients with COVID-19 who had undergone upper or lower extremity venous duplex ultrasonography at an academic health system in New York City from March 3, 2020 to April 12, 2020 with follow-up through May 12, 2020. A cohort of hospitalized patients without COVID-19 (non–COVID-19) who had undergone venous duplex ultrasonography from December 1, 2019 to December 31, 2019 was used for comparison. The primary outcome was DVT. The secondary outcomes included pulmonary embolism, in-hospital mortality, admission to the intensive care unit, and antithrombotic therapy. Multivariable logistic regression was performed to identify the risk factors for DVT and mortality. Results Of 443 patients (COVID-19, n = 188; and non–COVID-19, n = 255) who had undergone venous duplex ultrasonography, the COVID-19 cohort had had a greater incidence of DVT (31% vs 19%; P = .005) than had the non–COVID-19 cohort. The incidence of pulmonary embolism was not significantly different statistically between the COVID-19 and non–COVID-19 cohorts (8% vs 4%; P = .105). The DVT location in the COVID-19 group was more often distal (63% vs 29%; P < .001) and bilateral (15% vs 4%; P < .001). The duplex ultrasound findings had a significant impact on the antithrombotic plan; 42 patients (72%) with COVID-19 in the DVT group had their therapy escalated and 49 (38%) and 3 (2%) had their therapy escalated and deescalated in the non-DVT group, respectively ( P < .001). Within the COVID-19 cohort, the D-dimer level was significantly greater in the DVT group at admission (2746 ng/mL vs 1481 ng/mL; P = .004) and at the duplex examination (6068 ng/mL vs 3049 ng/mL; P < .01). On multivariable analysis, male sex (odds ratio [OR], 2.27; 95% confidence interval [CI], 1.06-4.87; P = .035), intensive care unit admission (OR, 3.42; 95% CI, 1.02-11.44; P = .046), and extracorporeal membrane oxygenation (OR, 5.5; 95% CI, 1.01-30.13; P = .049) were independently associated with DVT. Conclusions Given the high incidence of venous thromboembolic events in this population, we support the decision to empirically initiate therapeutic anticoagulation for patients with a low bleeding risk and severe COVID-19 infection. Duplex ultrasonography should be reserved for patients with a high clinical suspicion of venous thromboembolism for whom anticoagulation ther...

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Objectives: Carotid body tumors (CBTs) are rare neuroendocrine paragangliomas that are typically asymptomatic and benign with a low rate of biochemical functionality. Historically, early surgical excision was recommended to prevent development of CBT-related complications. Yet, CBT resection can result in significant injury to cranial nerves and the carotid artery. Recent work has shown successful primary observation without resection of noncarotid body, cranial paragangliomas (glomus jugulare, tempanyomastoid, vagal body) with slow growth and a low rate of neuropathies. We hypothesize that primary observation of CBTs is safe and can be considered for the majority of CBTs.Methods: This was a retrospective cohort study of patients at a multihospital health care system with radiologic identification or surgical resection of CBT (2000CBT ( -2019. Tumor size (greatest diameter), associated symptoms, and interventions were recorded at initial evaluation and throughout follow-up. Categorical variables were presented as frequency (percent) and continuous as mean 6 standard deviation or median (interquartile range [IQR]) for normally or skewed distributions, respectively.Results: A total of 108 patients (mean age, 59.4 6 19 years; 67% female; 87% white) underwent initial evaluation for 123 CBTs (mean diameter, 2.4 6 1.2 cm; 43% right; 14% bilateral) with otolaryngologists (48%), vascular surgeons (30%), or other providers (22%). Fifty-six CBTs were initially resected, 63 observed, and 4 irradiated (Fig) . The overall median followup was 4.7 years (IQR, 2.6-9.1 years). Initially observed CBTs were, on average, stable in size (mean, 0.1 6 0.5 cm/year), none became biochemically active, and 2 patients became symptomatic. One patient experienced pain from hemorrhagic conversion treated successfully with radiation and 1 sternal pain from metastatic disease successfully treated with CBT resection and sternal radiation therapy. In total, 62 CBTs were resected, 55 never intervened upon, and 5 irradiated (Table ). Of the 62 surgically resected CBTs, 9 CBTs (16%) underwent preoperative embolization, 6 CBTs (10%) had malignant pathology in 6 patients, of which 4 (67%) had known somatic mutations (polymerase epsilon [n ¼ 1], succinate dehydrogenase-D gene [n ¼ 3]). Of the 59 patients who underwent surgical resection, 42% of patients had postoperative complications, notably including stroke (n ¼ 2), vocal cord paralysis (n ¼ 4), dysphagia (n ¼ 4), and facial asymmetry (n ¼ 7). Four resected CBTs locally recurred, only 2 of which had malignant pathology.Conclusions: Patients with newly diagnosed CBTs require biochemical functionality and known somatic mutation assessment. In the absence of these findings, CBTs can be primarily observed with annual imaging and symptom monitoring as a safe alternative to immediate resection, which demonstrates a high rate of vascular and cranial nerve-related complications and an ongoing risk of recurrence.

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