ABSTRACT
Aortitis and aortic dissection are very rare in children. The clinical presentation of aortitis varies across a spectrum, ranging from incidental findings to fatal aortic dissection and rupture. A high index of suspicion is needed to establish an accurate and timely diagnosis. Here, we present an unfortunate case of fatal infective aortitis with aortic rupture and cardiac tamponade in a healthy toddler. Postmortem report implicated Kingella kingae as the causative organism of aortic pseudoaneurysm and rupture, leading to the instantaneous death of the child.
Subject(s)
Aortic Dissection , Aortic Rupture , Aortitis , Cardiac Tamponade , Soft Tissue Infections , Humans , Aortitis/complications , Aortitis/diagnostic imaging , Aortic Rupture/complications , Aortic Rupture/diagnostic imaging , Cardiac Tamponade/diagnostic imaging , Cardiac Tamponade/etiology , Aorta/diagnostic imagingABSTRACT
After recovering from severe COVID-19 infection, 2 women presented with chest pain. Computed tomographic angiography suggested acute ascending aortic dissection. At operation in both patients, the ascending aorta was encased in dense fibrous tissue, within which were focal collections of mononuclear cells, including many plasma cells. There was no entry tear or dissection. Such findings we have not encountered previously, and PubMed search of "periaortic fibrosis and COVID-19" yielded no similar cases or possible relation.
Subject(s)
Aortic Aneurysm, Thoracic , Aortic Dissection , COVID-19 , Humans , Female , COVID-19/complications , Aortic Dissection/complications , Aortic Dissection/diagnosis , Aorta/diagnostic imaging , Aorta/surgery , Computed Tomography Angiography , Fibrosis , Aortic Aneurysm, Thoracic/surgeryABSTRACT
AIM: Chest computed tomography (CT) imaging plays a diagnostic and prognostic role in Coronavirus disease 2019 (COVID-19) patients. This study aimed to investigate and compare predictive capacity of main pulmonary artery diameter (MPA), ascending aorta diameter (AAo), and MPA-to-AAo ratio to determine in-hospital mortality in COVID-19 patients. MATERIALS AND METHODS: This retrospective study included 255 hospitalized severe or critical COVID-19 patients. MPA was measured at the level of pulmonary artery bifurcation perpendicular to the direction of the vessel through transverse axial images and AAo was measured by using the same CT slice at its maximal diameter. MPA-to-AAo ratio was calculated by division of MPA to AAo. RESULTS: Multivariate logistic regression model yielded MPA ≥29.15 mm (OR: 4.95, 95% CI: 2.01-12.2, p = 0.001), MPA (OR: 1.28, 95% CI: 1.13-1.46, p < 0.001), AAo (OR: .90, 95% CI: .81-.99, p = 0.040), and MPA-to-AAo ratio ≥.82 (OR: 4.67, 95% CI: 1.86-11.7, p = 0.001) as independent predictors of in-hospital mortality. Time-dependent multivariate Cox-proportion regression model demonstrated MPA ≥29.15 mm (HR: 1.96, 95% CI: 1.03-3.90, p = 0.047) and MPA (HR: 1.08, 95% CI: 1.01-1.17, p = 0.048) as independent predictors of in-hospital mortality, whereas AAo and MPA-to-AAo ratio did not reach statistical significance. CONCLUSION: Pulmonary artery enlargement strongly predicts in-hospital mortality in hospitalized COVID-19 patients. MPA, which can be calculated easily from chest CT imaging, can be beneficial in the prognostication of these patients.
Subject(s)
COVID-19 , Aorta/diagnostic imaging , Humans , Prognosis , Pulmonary Artery/diagnostic imaging , Retrospective Studies , SARS-CoV-2 , Tomography, X-Ray ComputedSubject(s)
COVID-19 , Pneumonia , Thrombosis , Aorta/diagnostic imaging , Humans , SARS-CoV-2 , Thrombosis/complications , Thrombosis/diagnostic imagingABSTRACT
We report a case of aortoenteric fistula 2 years following endovascular aortic aneurysm repair (EVAR) for mycotic aneurysm presenting as upper gastrointestinal bleeding. Initial CT angiogram did not reveal the bleeding or connection to bowel, but endoscopy was suspicious of endograft in the duodenum. Management required a multidisciplinary approach. To stabilise the patient and to control bleeding, a 'bridging' endograft extension was performed. This was followed by open surgical removal of the EVAR endograft and lower limb in situ revascularisation. During postoperative recovery, the patient developed atypical, staged multisystemic symptoms (cardiac, pulmonary and neurological). With increasing awareness of the COVID-19 pandemic, the patient was found SARS-CoV-2-positive, which explained the progression of his symptoms. This was also reflected on other case reports in literature later.
Subject(s)
Aneurysm, Infected/surgery , Aortic Aneurysm, Abdominal/surgery , COVID-19/complications , Endovascular Procedures/methods , Intestinal Fistula/complications , Vascular Fistula/complications , Aged , Anti-Bacterial Agents/therapeutic use , Aorta/diagnostic imaging , Aorta/surgery , COVID-19/diagnosis , COVID-19/therapy , COVID-19 Nucleic Acid Testing/methods , Computed Tomography Angiography/methods , Continuous Positive Airway Pressure/methods , Humans , Intestinal Fistula/diagnostic imaging , Intestinal Fistula/surgery , Male , SARS-CoV-2 , Vascular Fistula/diagnostic imaging , Vascular Fistula/surgerySubject(s)
Aorta/drug effects , Arteritis/chemically induced , Iliac Artery/drug effects , Immune Checkpoint Inhibitors/adverse effects , Melanoma/drug therapy , Skin Neoplasms/drug therapy , Aged , Aged, 80 and over , Aorta/diagnostic imaging , Aorta/immunology , Arteritis/diagnostic imaging , Arteritis/immunology , CTLA-4 Antigen/antagonists & inhibitors , Female , Fluorodeoxyglucose F18 , Humans , Iliac Artery/diagnostic imaging , Iliac Artery/immunology , Immunity, Innate/drug effects , Male , Melanoma/immunology , Melanoma/pathology , Middle Aged , Neoplasm Staging , Positron Emission Tomography Computed Tomography , Programmed Cell Death 1 Receptor/antagonists & inhibitors , Radiopharmaceuticals , Retrospective Studies , Risk Factors , Skin Neoplasms/immunology , Skin Neoplasms/pathologyABSTRACT
Coronavirus disease 2019 (COVID-19) could predispose to both venous and arterial thromboembolism, in an exaggerated immune response to the virus, especially in severe patients. Even though aortic clots are a rare entity, the pro-coagulant nature of COVID-19 is associated with thrombosis in atypical locations and should be considered in patients with severe abnormalities in coagulation parameters. We describe a series of three cases of aortic thrombi diagnosed by computerized tomography (CT) angiography in patients with confirmed SARS-CoV-2 infection.