Intramural Hematoma as Unexpected Complication of COVID-19 Infection

Abstract

Novel coronavirus disease-2019 (COVID-19) is an ominous infectious disease that seems capable to attack any organ system, leading in the most severe cases to patient death. COVID-19 has been associated with multiple cardiovascular complications of inflammatory and immune origin, leading to a wide spectrum of vascular damage, myocardial injury, stroke, and pulmonary obstruction. We report the case of a patient with COVID-19 infection who developed an acute aortic syndrome with the characteristics of aortic intramural hematoma.

Systemic Inflammation May Induce Cardiac Injury in COVID-19 Patients Including Children and Adolescents Without Underlying Cardiovascular Diseases: A Systematic Review

“…The characteristics and demographic features of the total of 45 COVID-19 patients with CI included in the selected case reports and case series are demonstrated in supplementary table 3 [ [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] ]. Patients' age ranged from 38 days to 74 years and approximately 62% of them were males.…”

“…Almost all studies (except Del Barba et al, 2020, Latimer et al, and Zeng et al, 2020) reported elevated CRP and eight studies reported CRP levels above 200 mg/L [ [20] , [21] , [22] , [26] , [27] , [28] ] . IL-6 was detected in multiple studies at elevated levels ranging from 17.06 to 7305 pg/mL [ 21 , 22 , 24 , 26 , 32 , 33 , [36] , [37] , [38] , 40 ]. Ferritin levels ranging from 600 to 7634 ng/mL were reported [ 21 , 22 , 26 , [28] , [29] , [30] , [32] , [33] , [34] , 36 , 38 ].…”

“…The D-dimer serum level was not reported; however, elevated fibrinogen levels were observed suggesting widespread micro and macro-vascular thrombosis. Furthermore, Terzi et al reported a COVID-19 patient with characteristics of aortic intramural hematoma supporting macrovascular involvement [ 37 ].…”

“…However, the two other patients who developed cardiomyopathy, cardiogenic shock [ 23 ], and pericardial effusion [ 31 ] secondary to myocarditis have recovered. One patient had Takostubo [ 36 ] syndrome and three developed other types of CI such as intramural hemorrhage [ 37 ], decompensated heart failure with reduced ejection fraction (HfrEF), atrial dysrhythmias [ 38 ] and decreased ejection fraction with left arterial enlargement [ 39 ], all of which have recovered.…”

COVID 19— Perspective of an Italian Center

“…At our center, we treated an acute dissection of the aorta in a patient already known as positive to SARS‐CoV‐2 while isolating at home. The course was burdened by respiratory complications and the need for prolonged ventilation, but in the end, the patient survived and was discharged 29 …”