Is COVID Evolution Due to Occurrence of Pulmonary Vascular Thrombosis?

Saba, Luca; Sverzellati, Nicola

doi:10.1097/rti.0000000000000530

Cited by 30 publications

(39 citation statements)

References 15 publications

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“…Furthermore, unlike COVID-19, neither SARS nor MERS were significant associated with lymphadenopathy, pleural effusion, nodules, or cavitations [65]. Moreover, COVID-19 CT features demonstrated some overlap with other pulmonary conditions such as pulmonary edema, pulmonary hemorrhage [67], bronchiolitis obliterans, chronic obstructive pulmonary disease and druginduced lung disease [62]. In pulmonary edema, chest CT demonstrates GGOs with central distribution, often associated with smooth interlobular septal thickening, pleural effusion, and cardiomegaly, indicating congestive heart failure.…”

Section: Differential Diagnosismentioning

confidence: 94%

Chest CT features of coronavirus disease 2019 (COVID-19) pneumonia: key points for radiologists

et al. 2020

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COVID-19 is an emerging infection caused by a novel coronavirus that is moving so rapidly that on 30 January 2020 the World Health Organization declared the outbreak a Public Health Emergency of International Concern and on 11 March 2020 as a pandemic. An early diagnosis of COVID-19 is crucial for disease treatment and control of the disease spread. Real-time reverse-transcription polymerase chain reaction (RT-PCR) demonstrated a low sensibility, therefore chest computed tomography (CT) plays a pivotal role not only in the early detection and diagnosis, especially for false negative RT-PCR tests, but also in monitoring the clinical course and in evaluating the disease severity. This paper reports the CT findings with some hints on the temporal changes over the course of the disease: the CT hallmarks of COVID-19 are bilateral distribution of ground glass opacities with or without consolidation in the posterior and peripheral lung, but the predominant findings in later phases include consolidations, linear opacities, "crazy-paving" pattern, "reversed halo" sign and vascular enlargement. The CT findings of COVID-19 overlap with the CT findings of other diseases, in particular the viral pneumonia including influenza viruses, parainfluenza virus, adenovirus, respiratory syncytial virus, rhinovirus, human metapneumovirus, etc. There are differences as well as similarities in the CT features of COVID-19 compared with those of the severe acute respiratory syndrome. The aim of this article is to review the typical and atypical CT findings in COVID-19 patients in order to help radiologists and clinicians to become more familiar with the disease.

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Section: Differential Diagnosismentioning

confidence: 94%

Chest CT features of coronavirus disease 2019 (COVID-19) pneumonia: key points for radiologists

et al. 2020

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“…A severe disease is suggested by a level of D-dimers above 500 ng/mL, and a possible death -by a level above 1000 ng/mL. Frequent damage in the lower lobe and peripheral lung regions is an argument for the potential thrombotic role of this virus 22 .…”

Section: Hypothesis: Thrombosis In the Pulmonary Circulation Induced mentioning

confidence: 99%

Coagulation disorders in SARS-CoV-2 infection

Mihăilă¹,

Mihaila²

2020

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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A better understanding of the pathogenetic mechanisms triggered by SARS-CoV-2 infection may contribute to a more effective management of patients with COVID-19. Coagulation dysfunction is a key pathogenetic element of this disease as well as a challenge for practitioners. Marked inflammatory process found in severe forms of COVID-19, the complement activation, the cytokine storm, and disruption of the renin-angiotensin-aldosterone system are involved in the onset of thrombotic microangiopathy and large vessel coagulopathy. Virus-induced procoagulant activity occurs at the systemic level. Intravascular microthrombi disrupt vascularization in various tissues and organs, contributing to the occurrence of multiorgan failure and explain the higher morbidity and all-cause mortality of patients. It is estimated that almost 20% of patients with COVID-19 have significant coagulation disorders, and about a quarter of those hospitalized in intensive care units are prone to develop thrombosis events under prophylactic anticoagulant treatment. Some of patients who have been immunized after healing from the SARS-CoV-2 infection have a hypercoagulable state and are prone to develop thrombosis. Hypercoagulability is supported by thrombelastographic analysis: patients have an acceleration of the propagation phase of blood clot formation and higher clot strength. Markers of coagulation dysfunction in SARS-CoV2 are: decreased platelet count, increased INR, presence of fibrin degradation products, and especially higher plasma levels of D-dimers, which predict unfavorable outcome in these patients. Age, pre-existing diseases and associated risk factors, together with careful monitoring of clinical evolution and laboratory parameters allow the choice of the best personalized prophylactic or curative anticoagulant treatment.

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“…Based on the data provided in the series of clinical and autopsy cases, VTE is a frequent pathological process in patients with COVID-19. It affects two possible non-exclusive forms, a "microvascular" with micro thrombi in lung areas affected by DAD, in relation to microangiopathy, which can progress into the form of local pulmonary thrombosis 56,57 . This form would be consistent with a greater number of cases of segmental- sub segmental involvement, and even in those cases in the absence of DVT and presence of PE demonstrated by CT angiography.…”

Section: Discussionmentioning

confidence: 99%