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1.
Lung India ; 39(SUPPL 1):S214, 2022.
Article in English | EMBASE | ID: covidwho-1857056

ABSTRACT

Background: COVID-19 is associated with an increased risk of superimposed bacterial and fungal infections. Pleural aspergillosis is an uncommon manifestation of invasive aspergillosis. We report a case of pleural aspergillosis with pulmonary artery thrombosis after COVID-19 with favourable outcome. Case Study: A 67-year male, diabetic, IHD post CABG, with moderate COVID-19 disease 2 months ago, presented with 1 week history of productive cough, breathlessness and chest pain. Examination revealed hypoxia, tachycardia and diminished breath sounds on right side. Right hydropneumothorax was noted on imaging, tube thoracostomy was done. Pleural fluid investigations were suggestive of pyothorax. CECT-thorax showed cavitary consolidation in right lower lobe. Patient was treated with IV antibiotics. However, there was persistent air leak and tachycardia. 2D-ECHO showed mild PAH. D-Dimer was high, CTPA revealed partial thrombosis of right posterior basal pulmonary arteries. Pleural fluid fungal culture yielded Aspergillus fumigatus. Patient was initiated on oral voriconazole and anticoagulants. He showed marked improvement and in 5 days ICD was removed. Patient is on regular follow-up. Discussion: COVID-19 associated superimposed infections have been reported with high mortality rates. The use of corticosteroids and/or IL-6 antagonists have been implicated with the fungal infections. Pleural aspergillosis is rare. Diagnosis is usually based on clinical and microbiological evidence. A key finding in invasive aspergillosis is angioinvasion which leads to thrombosis and tissue infarction. Conclusion: Clinicians should have high index of suspicion for superimposed fungal infections in COVID-19. Early initiation of treatment brings down morbidity and mortality.

2.
J Clin Med ; 11(9)2022 May 07.
Article in English | MEDLINE | ID: covidwho-1847358

ABSTRACT

(1) Background: We aimed to describe the clinical and imaging characteristics of patients diagnosed with pulmonary artery thrombosis (PAT) despite receiving anticoagulation with low-molecular-weight heparin (LMWH). (2) Methods: We retrospectively studied all hospitalized COVID-19 adult patients diagnosed with PAT between March 2020 and December 2021, who received LMWH for ≥72 h until the diagnosis of PAT. Acute PAT was confirmed by a CT pulmonary angiogram. (3) Results: We included 30 severe and critical COVID-19 patients. Median age was 62 (54-74) years, with 83.3% males, and comorbidities seen in 73.3%. PAT was diagnosed despite prophylactic (23.3%), intermediate (46.6%) or therapeutic (30%) doses of LMWH for a median time of 8 (4.7-12) days. According to their Wells score, 80% of patients had a low probability of pulmonary embolism diagnosis. PAT was localized in the lower lobes of the lungs in 76.6% of cases with 33.3% having bilateral involvement, with the distal, peripheral arteries being the most affected. At the PAT diagnosis we found a worsening of respiratory function, with seven patients progressing to mechanical ventilation (p = 0.006). The in-hospital mortality was 30%. (4) Conclusions: PAT should be considered in patients with severe and critical COVID-19, mainly in elderly male patients with comorbidities, irrespective of Wells score and LMWH anticoagulation.

3.
Ther Adv Hematol ; 12: 20406207211048364, 2021.
Article in English | MEDLINE | ID: covidwho-1582496

ABSTRACT

BACKGROUND: COVID-19 patients present with both elevated D-dimer and a higher incidence of pulmonary embolism (PE). This single-centre retrospective observational study investigated the prevalence of early PE in COVID-19 patients and its relation to D-dimer at presentation. METHODS: The study included 1038 COVID-19-positive patients, with 1222 emergency department (ED) attendances over 11 weeks (16 March to 31 May 2020). Computed tomography pulmonary angiogram (CTPA) for PE was performed in 123 patients within 48 h of ED presentation, of whom 118 had D-dimer results. The remaining 875 attendances had D-dimer performed. RESULTS: CTPA performed in 11.8% of patients within 48 h of ED presentation confirmed PE in 37.4% (46/123). Thrombosis was observed at all levels of pulmonary vasculature with and without right ventricular strain. In the CTPA cohort, patients with PE had significantly higher D-dimer, prothrombin time, C-reactive protein, troponin, total bilirubin, neutrophils, white cell count and lower albumin compared with non-PE patients. However, there was no difference in the median duration of inpatient stay or mortality. A receiver operator curve analysis demonstrated that D-dimer could discriminate between PE and non-PE COVID-19 patients (area under the curve of 0.79, p < 0.0001). Furthermore, 43% (n = 62/145) of patients with D-dimer >5000 ng/ml had CTPA with PE confirmed in 61% (n = 38/62), that is, 26% of >5000 ng/ml cohort. The sensitivity and specificity were related to D-dimer level; cutoffs of 2000, 3000, 4000, and 5000 ng/ml, respectively, had a sensitivity of 93%, 90%, 90% and 86%, and a specificity of 38%, 54%, 59% and 68%, and if implemented, an additional 229, 141, 106 and 83 CTPAs would be required. CONCLUSION: Our data suggested an increased PE prevalence in COVID-19 patients attending ED with an elevated D-dimer, and patients with levels >5000 ng/ml might benefit from CTPA to exclude concomitant PE.

4.
Respir Med ; 172: 106135, 2020 10.
Article in English | MEDLINE | ID: covidwho-773282

ABSTRACT

PURPOSE: Patients hospitalized for infection with SARS-CoV-2 typically present with pneumonia. The respiratory failure is frequently complicated by pulmonary embolism in segmental pulmonary arteries. The distribution of pulmonary embolism in regard to lung parenchymal opacifications has not been investigated yet. METHODS: All patients with COVID-19 treated at a medical intensive care unit between March 8th and April 15th, 2020 undergoing computed tomography pulmonary angiography (CTPA) were included. All CTPA were assessed by two radiologists independently in respect to parenchymal changes and pulmonary embolism on a lung segment basis. RESULTS: Out of 22 patients with severe COVID-19 treated within the observed time period, 16 (age 60.4 ± 10.2 years, 6 female SAPS2 score 49.2 ± 13.9) underwent CT. A total of 288 lung segment were analyzed. Thrombi were detectable in 9/16 (56.3%) patients, with 4.4 ± 2.9 segments occluded per patient and 40/288 (13.9%) segments affected in the whole cohort. Patients with thrombi had significantly worse segmental opacifications in CT (p < 0.05) and all thrombi were located in opacitated segments. There was no correlation between d-dimer level and number of occluded segmental arteries. CONCLUSIONS: Thrombi in segmental pulmonary arteries are common in COVID-19 and are located in opacitated lung segments. This might suggest local clot formation.


Subject(s)
Computed Tomography Angiography , Coronavirus Infections , Lung/diagnostic imaging , Pandemics , Pneumonia, Viral , Pulmonary Artery/diagnostic imaging , Pulmonary Embolism , Respiratory Distress Syndrome , Thrombosis , Betacoronavirus/isolation & purification , Blood Coagulation , COVID-19 , Computed Tomography Angiography/methods , Computed Tomography Angiography/statistics & numerical data , Coronavirus Infections/blood , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Correlation of Data , Female , Humans , Male , Middle Aged , Pneumonia, Viral/blood , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/etiology , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Pulmonary Embolism/diagnosis , Pulmonary Embolism/etiology , Radiography, Thoracic/methods , Radiography, Thoracic/statistics & numerical data , Respiratory Distress Syndrome/diagnosis , Respiratory Distress Syndrome/virology , Retrospective Studies , SARS-CoV-2 , Thrombosis/diagnostic imaging , Thrombosis/etiology
5.
Quant Imaging Med Surg ; 10(9): 1852-1862, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-745372

ABSTRACT

BACKGROUND: Increased prevalence of acute pulmonary embolism in COVID-19 has been reported in few recent studies. Some works have highlighted pathological changes on lung microvasculature with local pulmonary intravascular coagulopathy that may explain pulmonary artery thrombosis found on pulmonary computed tomography (CT) angiography. The objective of our study was to describe lung perfusion disorders assessed by pulmonary dual-energy CT (DECT) angiography in severe COVID-19 patients. METHODS: This single center retrospective study included 85 consecutive patients with a reverse transcriptase-polymerase chain reaction diagnosis of SARS-CoV-2 who underwent a pulmonary DECT angiography between March 16th 2020 and April 22th 2020. Pulmonary DECT angiography was performed when the patient had severe clinical symptoms or suffered from active neoplasia or immunosuppression. Two chest radiologists performed pulmonary angiography analysis in search of pulmonary artery thrombosis and a blinded semi quantitative analysis of iodine color maps focusing on the presence of parenchymal ischemia. The lung parenchyma was divided into volumes based on HU values. DECT analysis included lung segmentation, total lungs volume and distribution of lung perfusion assessment. RESULTS: Twenty-nine patients (34%) were diagnosed with pulmonary artery thrombosis, mainly segmental (83%). Semi-quantitative analysis revealed parenchymal ischemia in 68% patients of the overall population, with no significant difference regarding absence or presence of pulmonary artery thrombosis (23 vs. 35, P=0.144). Inter-reader agreement of parenchymal ischemia between reader 1 and 2 was substantial [0.74; interquartile range (IQR): 0.59-0.89]. Volume of ischemia was significantly higher in patients with pulmonary artery thrombosis [29 (IQR, 8-100) vs. 8 (IQR, 0-45) cm3, P=0.041]. Lung parenchyma was divided between normal parenchyma (59%, of which 34% was hypoperfused), ground glass opacities (10%, of which 20% was hypoperfused) and consolidation (31%, of which 10% was hypoperfused). CONCLUSIONS: Pulmonary perfusion evaluated by iodine concentration maps shows extreme heterogeneity in COVID-19 patients and lower iodine levels in normal parenchyma. Pulmonary ischemic areas were more frequent and larger in patients with pulmonary artery thrombosis. Pulmonary DECT angiography revealed a significant number of pulmonary ischemic areas even in the absence of visible pulmonary arterial thrombosis. This may reflect microthrombosis associated with COVID-19 pneumonia.

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