Pulmonary Vein Thrombosis in COVID-19

Goddard, Stephanie A.; Tran, Daniel Q.; Chan, Michael F.; Honda, Michelle N.; Weidenhaft, Mandy; Triche, Benjamin L

doi:10.1016/j.chest.2020.11.064

Cited by 15 publications

(23 citation statements)

References 16 publications

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“…Diagnosis of PVT is through imaging and pathology. The imaging modalities used include transesophageal echocardiography, CT scanning, MRI (magnetic resonance imaging), and pulmonary angiography [ 4 ]. There is no specific treatment for PVT.…”

Section: Discussionmentioning

confidence: 99%

“…Notably, patients with COVID-19 have an increased tendency to a prothrombotic state, most commonly presenting as stroke or pulmonary embolism. However, atypical sites of thrombosis have been reported, including basilic vein thrombosis, digital ischemia, and thoracic aorta [ 2 - 4 ]. We present a patient with COVID-19 ARDS who developed pulmonary vein thrombosis (PVT), a rare but life-threatening condition.…”

Section: Introductionmentioning

confidence: 99%

“…We present a patient with COVID-19 ARDS who developed pulmonary vein thrombosis (PVT), a rare but life-threatening condition. To our knowledge, only two other cases have been reported of PVT in the setting of COVID-19 pneumonia [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Pulmonary Vein Thrombosis in the Setting of COVID-19 Infection: A Case Report

Araim¹,

Dabek²,

Shehadeh³

et al. 2022

Cureus

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The novel coronavirus SARS-CoV-2 (COVID-19) affects all three branches of Virchow's triad. It increases the risk of thrombosis and thromboembolic events. Pulmonary embolism and stroke are most commonly reported. However, there is an increasing number of cases demonstrating thrombosis in otherwise uncommon anatomical areas. In this presentation, we will explore the potential causes of pulmonary vein thrombosis secondary to COVID-19.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pulmonary Vein Thrombosis in the Setting of COVID-19 Infection: A Case Report

Araim¹,

Dabek²,

Shehadeh³

et al. 2022

Cureus

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“…However, LVO stroke from pulmonary clot embolism is well established postlung lobectomy, 52 and there have been several case reports of pulmonary vein thrombosis since onset of COVID-19, which represents a notable increase in incidence of a very rare disease. [9][10][11][12] Additionally, pulmonary venous thrombosis is part of the PIC complex on autopsy examination. 6 Therefore, a causative link between pulmonary vein thrombosis and stroke has already been validated both in non-COVID and COVID stroke, but we acknowledge the limitation that pulmonary vein thrombosis has not been widely reported on CT pulmonary angiography which is frequently performed in patients with COVID-19, but there are several valid reasons why this is so.…”

Section: Other Considerations and Limitations Of The Tricompartmental...mentioning

confidence: 99%

“…32,33,[42][43][44][45][46][47] In this article, we describe how disruption of the lung tricompartment in the presence of inflammatory cytokines, hypoxia, endotheliopathy, and hypercoagulability leads to in situ thrombosis within the draining pulmonary venules, from which emboli may dislodge into the systemic circulation, causing stroke. 9 Immunothrombotic disruption of the alveolar-capillary barrier results in not only dislodgement of immune-rich emboli but also discharge of RNA which is extremely thrombogenic (RNAaemia) and other viral proteins into the circulation, which could exacerbate immunothrombosis in the cerebral vasculature in a manner similar to that occurring in the lungs. 48,49…”

mentioning

confidence: 99%

Perspective: The Case for Acute Large Vessel Ischemic Stroke in COVID-19 Originating Within Thrombosed Pulmonary Venules

Meaney

O’Donnell

Bridgewood

et al. 2022

Stroke

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The main burden of SARS-CoV-2 falls on the lungs but neurological manifestations, the most disabling of which are strokes and which correlate with disease severity, are common. We proffer a novel mechanism for acute COVID-19 stroke whereby pulmonary vein clots developing within the characteristic pulmonary intravascular thrombotic lesions can embolize to the brain. Appreciation of this mechanism requires an understanding of the tricompartmental model of lung parenchyma oxygenation (the alveolus, the bronchial artery, and the pulmonary artery), all of which are compromised in COVID-19. Of these 3 sources, the bronchial artery plays a crucial role in COVID-19 stroke because the unique collaterals from bronchial artery to pulmonary vein which exist under normal physiological conditions (and which maintain venous patency when the pulmonary artery is blocked by embolus) are occluded, thus leading to venular thrombosis in the presence of hypercoagulability. Dislodgement of clots from this source translocates the pathology to the brain and is a disease mechanism, formerly rare, which may account for many cases of large vessel occlusion stroke in COVID-19. This mechanism extends the concept of cardioembolic stroke from endocardium retrogradely into the pulmonary circulation with which the left cardiac chambers lie in direct continuity, and which is an accepted stroke mechanism under other circumstances such as lung lobectomy, where surgical ligation of the pulmonary vein creates a blind sac from which thrombi can embolize. The proposed model is supported by postmortem studies which have demonstrated venular thrombosis and by case reports of pulmonary vein thrombosis in COVID-19. This concept provides a more plausible cause for COVID-19 associated large vessel occlusion stroke than other putative mechanisms, such as cerebral endotheliitis, cytokine storm, and hypercoagulopathy, although it is acknowledged that the latter mechanism contributes to the genesis of pulmonary vein clots. Recognizing that extrapulmonary manifestations including stroke arise within thrombosed pulmonary veins is key to understanding of neurological manifestations of SARS-CoV-2 infection.

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Pulmonary circulation abnormalities in post-acute COVID-19 syndrome: dual-energy CT angiographic findings in 79 patients

Mohamed

Broucker

Duhamel³

et al. 2023

Eur Radiol

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Objectives To evaluate the frequency and pattern of pulmonary vascular abnormalities in the year following COVID-19. Methods The study population included 79 patients remaining symptomatic more than 6 months after hospitalization for SARS-CoV-2 pneumonia who had been evaluated with dual-energy CT angiography. Results Morphologic images showed CT features of (a) acute (2/79; 2.5%) and focal chronic (4/79; 5%) PE; and (b) residual post COVID-19 lung infiltration (67/79; 85%). Lung perfusion was abnormal in 69 patients (87.4%). Perfusion abnormalities included (a) perfusion defects of 3 types: patchy defects ( n = 60; 76%); areas of non-systematized hypoperfusion ( n = 27; 34.2%); and/or PE-type defects ( n = 14; 17.7%) seen with (2/14) and without (12/14) endoluminal filling defects; and (b) areas of increased perfusion in 59 patients (74.9%), superimposed on ground-glass opacities (58/59) and vascular tree-in-bud (5/59). PFTs were available in 10 patients with normal perfusion and in 55 patients with abnormal perfusion. The mean values of functional variables did not differ between the two subgroups with a trend toward lower DLCO in patients with abnormal perfusion (74.8 ± 16.7% vs 85.0 ± 8.1). Conclusion Delayed follow-up showed CT features of acute and chronic PE but also two types of perfusion abnormalities suggestive of persistent hypercoagulability as well as unresolved/sequelae of microangiopathy. Clinical relevance statement Despite dramatic resolution of lung abnormalities seen during the acute phase of the disease, acute pulmonary embolism and alterations at the level of lung microcirculation can be identified in patients remaining symptomatic in the year following COVID-19. Key Points • This study demonstrates newly developed proximal acute PE/thrombosis in the year following SARS-CoV-2 pneumonia. • Dual-energy CT lung perfusion identified perfusion defects and areas of increased iodine uptake abnormalities, suggestive of unresolved damage to lung microcirculation. • This study suggests a complementarity between HRCT and spectral imaging for proper understanding of post COVID-19 lung sequelae. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-023-09618-9.

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Pulmonary Vein Thrombosis in COVID-19

Cited by 15 publications

References 16 publications

Pulmonary Vein Thrombosis in the Setting of COVID-19 Infection: A Case Report

Pulmonary Vein Thrombosis in the Setting of COVID-19 Infection: A Case Report

Perspective: The Case for Acute Large Vessel Ischemic Stroke in COVID-19 Originating Within Thrombosed Pulmonary Venules

Pulmonary circulation abnormalities in post-acute COVID-19 syndrome: dual-energy CT angiographic findings in 79 patients

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