Preliminary evidence supports the notion that COVID-19 patients may have an increased susceptibility to develop venous thromboembolism (VTE). However, the magnitude of this association still needs to be defined. Furthermore, clinical predictors of thrombogenesis, and the relationship with the inflammatory status are currently unknown. On this basis, we conducted a retrospective, observational study on 259 consecutive COVID-19 patients admitted to an academic tertiary referral hospital in Northern Italy between March 19th and April 6th, 2020. Records of COVID-19 patients with a definite VTE event were reviewed for demographic information, co-morbidities, risk factors for VTE, laboratory tests, and anticoagulation treatment. Twenty-five cases among 259 COVID-19 patients developed VTE (9.6%), all of them having a Padua score > 4, although being under standard anticoagulation prophylaxis since hospital admission. In the VTE subcohort, we found a significant positive correlation between platelet count (PLT) and either C reactive protein (CRP) (p < 0.0001) or lactate dehydrogenase (LDH) (p = 0.0013), while a significant inverse correlation was observed between PLT and mean platelet volume (p < 0.0001). Platelet-to-lymphocyte ratio significantly correlated with CRP (p < 0.0001). The majority of VTE patients was male and younger compared to non-VTE patients (p = 0.002 and p = 0.005, respectively). No significant difference was found in d-dimer levels between VTE and non VTE patients, while significantly higher levels of LDH (p = 0.04) and IL-6 (p = 0.04) were observed in VTE patients in comparison to non-VTE patients. In conclusion, our findings showed a quite high prevalence of VTE in COVID-19 patients. Raised inflammatory indexes and increased serum levels of pro-inflammatory cytokines should raise the clinical suspicion of VTE.

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The case report is a description of a single case of hepatic myelolipoma, a very rare benign hepatic tumor, evaluated with contrast sonography, in a 72-year-old female. It was previously reported as hyperechoic lesions at sonography. CEUS features of the lesion were: homogeneous hyperenhancement in the arterial phase and a slight hyperenhancement in the portal venous phase typical of benign tumors. The case report shows CEUS may help in differential diagnosis between benign and malignant lesions, but only the biopsy of the tumor and the pathological evaluation allows the diagnosis.Keywords Myelolipoma Á Liver Á Contrast Á Ultrasound Sommario Presentiamo la descrizione di un singolo caso di mielolipoma epatico, tumore benigno molto raro, studiato con mezzo di contrasto ecografico (CEUS) in una donna di 72 anni. Precedentemente la lesione era stata descritta ecograficamente come nodulo iperecogeno. Le caratteristiche CEUS erano quelle di una lesione con enhancement in fase arteriosa e debole enhancement in fase portale, caratteristiche tipiche di una lesione benigna. Il caso in esame mostra come la CEUS possa quindi aiutare nella diagnosi differenziale tra lesioni benigne e maligne, ma solo la biopsia del tumore e la valutazione patologica permettono la diagnosi finale.

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