Case Reports: Bronchial Mucosal Vasculature Is Also Involved in the Acute Vascular Distress Syndrome of COVID-19

Abstract

Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which targets the pulmonary vasculature is supposed to induce an intrapulmonary right to left shunt with an increased pulmonary blood flow. We report here what may be, to the best of our knowledge, the first videoendoscopic descriptions of an hypervascularization of the bronchial mucosa in two patients hospitalized for coronavirus disease 2019 (COVID-19) pneumonia.Cases Presentation: Two patients, 27- and 37-year-old, were addressed to our Pneumology department for suspicion of COVID-19 pneumonia. Their symptoms (fever, dry cough, and dyspnoea), associated to pulmonary ground glass opacities on thoracic CT, were highly suggestive of a COVID-19 disease despite repeated negative pharyngeal swabs RT-PCR. In both patients, bronchoscopy examination using white light was unremarkable but NBI bronchoscopy revealed a diffuse hypervascularization of the mucosa from the trachea to the sub-segmental bronchi, associated with dilated submucosal vessels. RT-PCR performed in bronchoalveolar lavage (BAL) confirmed the presence of Sars-CoV-2.Conclusions: These two case reports highlight the crucial importance of the vascular component of the viral disease. We suggest that such bronchial hypervascularization with dilated vessels contributes, at least in part, to the intrapulmonary right to left shunt that characterizes the COVID-19 related Acute Vascular Distress Syndrome (AVDS). The presence of diffuse bronchial hypervascularization in the context of COVID-19 pandemic should prompt the search for Sars-CoV-2 in BAL samples.

Cardiovascular Biomarkers for Prediction of in-hospital and 1-Year Post-discharge Mortality in Patients With COVID-19 Pneumonia

“…This may be an underlying, unifying mechanism responsible for the widespread systemic manifestations seen with SARSCoV-2 infection ( 38 ). On this regard, also term “Acute Vascular Distress Syndrome” was introduced, to account for the quite unique vascular pathophysiology in COVID-19 pneumonia ( 17 , 18 ). A key feature reported is a low ventilation-to-perfusion ratio, leading to an increased pulmonary blood flow with intrapulmonary right to left shunt ( 18 ).…”

“…Several studies have revealed a potential link between COVID-19 and endothelial dysfunction. On this regard, also the term “Acute Vascular Distress Syndrome” was introduced, to account for the vascular pathophysiology in COVID-19 pneumonia ( 17 , 18 ). This comprises vasoplegia along with a reduced ventilation-to-perfusion ratio, leading to an increased pulmonary blood flow with intrapulmonary right to left shunt ( 18 ).…”