ABSTRACT
[Figure: see text].
Subject(s)
COVID-19 Drug Treatment , COVID-19/physiopathology , Interleukin 1 Receptor Antagonist Protein/therapeutic use , Receptors, Interleukin-1/physiology , Animals , Antigens, CD/metabolism , COVID-19/complications , Cadherins/metabolism , Capillary Permeability , Caspase 1/metabolism , Disease Models, Animal , Down-Regulation/drug effects , Edema/physiopathology , Edema/prevention & control , Endothelium, Vascular/drug effects , Enzyme Activation , Fibrosis/prevention & control , Mice, Inbred C57BL , Mice, Transgenic , NLR Family, Pyrin Domain-Containing 3 Protein/metabolism , Neutrophils/physiology , Pulmonary Circulation , Receptors, Interleukin-1/antagonists & inhibitors , SARS-CoV-2 , Signal Transduction/drug effectsABSTRACT
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection continues to be a public health emergency and a pandemic of international concern. As of April 31st, the reported cases of COVID-19 are three million in 186 countries. Reported case fatality has crossed 200 thousand among which more than fifty thousand has been in the USA. Most patients present with symptoms of fever, cough, and shortness of breath following exposure to other COVID-19 patients. Respiratory manifestations predominate in patients with mild, moderate, severe illness. Imaging of patients with COVID-19 consistently reports various pulmonary parenchymal involvement. In this article we wanted to reinforce and review the various reported imaging patterns of cardiac and mediastinal involvement in COVID-19 patients. Among patients with COVID 19 who underwent various imaging of chest various cardiac findings including pericardial effusion, myocarditis, cardiomegaly has been reported. Most of these findings have been consistently reported in patients with significant acute myocardial injury, and fulminant myocarditis. Acute biventricular dysfunction has also been reported with subsequent improvement of the same following clinical improvement. Details of cardiac MRI is rather limited. In a patient with clinical presentation of acute myocarditis, biventricular myocardial interstitial edema, diffuse biventricular hypokinesia, increased ventricular wall thickness, and severe LV dysfunction has been reported. Among patients with significant clinical improvement in LV structure and function has also been documented. With increasing number of clinical cases, future imaging studies will be instrumental in identifying the various cardiac manifestations, and their relation to clinical outcome.
Subject(s)
Cardiomegaly/diagnostic imaging , Coronavirus Infections/diagnostic imaging , Heart/diagnostic imaging , Myocardial Ischemia/diagnostic imaging , Myocarditis/diagnostic imaging , Pericardial Effusion/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Ventricular Dysfunction, Left/diagnostic imaging , Betacoronavirus , COVID-19 , Cardiomegaly/physiopathology , Coronary Angiography , Coronavirus Infections/physiopathology , Echocardiography , Edema/diagnostic imaging , Edema/physiopathology , Heart/physiopathology , Humans , Magnetic Resonance Imaging , Myocardial Ischemia/physiopathology , Myocarditis/physiopathology , Pandemics , Pericardial Effusion/physiopathology , Pneumonia, Viral/physiopathology , Radiography, Thoracic , Recovery of Function , SARS-CoV-2 , Tomography, X-Ray Computed , Ventricular Dysfunction/diagnostic imaging , Ventricular Dysfunction/physiopathology , Ventricular Dysfunction, Left/physiopathologySubject(s)
Antibodies, Bacterial/blood , COVID-19/complications , Mucocutaneous Lymph Node Syndrome/complications , Mycoplasma pneumoniae/pathogenicity , Pneumonia, Mycoplasma/complications , SARS-CoV-2/pathogenicity , Severe Acute Respiratory Syndrome/complications , Adolescent , Blotting, Western , COVID-19/diagnosis , COVID-19/pathology , COVID-19/virology , COVID-19 Testing , Child , Child, Preschool , Coinfection , Conjunctivitis/diagnosis , Conjunctivitis/physiopathology , Edema/diagnosis , Edema/physiopathology , Exanthema/diagnosis , Exanthema/physiopathology , Female , Fever/diagnosis , Fever/physiopathology , Humans , Infant , Male , Mucocutaneous Lymph Node Syndrome/diagnosis , Mucocutaneous Lymph Node Syndrome/pathology , Mucocutaneous Lymph Node Syndrome/virology , Mycoplasma pneumoniae/growth & development , Pneumonia, Mycoplasma/diagnosis , Pneumonia, Mycoplasma/microbiology , Pneumonia, Mycoplasma/pathology , SARS-CoV-2/growth & development , Severe Acute Respiratory Syndrome/diagnosis , Severe Acute Respiratory Syndrome/pathology , Severe Acute Respiratory Syndrome/virology , Stomatitis/diagnosis , Stomatitis/physiopathologyABSTRACT
Systemic capillary leak syndrome is a rare disorder characterized by dysfunctional inflammatory response, endothelial dysfunction, and extravasation of fluid from the vascular space to the interstitial space leading to shock, hemoconcentration, hypoalbuminemia, and subsequent organ failure. The condition may be idiopathic or secondary to an underlying cause, which can include viral infections. Here we describe a patient with acute coronavirus disease 2019 (COVID-19) infection who presented with hemoconcentration, shock, and hypoalbuminemia. The patient subsequently developed rhabdomyolysis and compartment syndrome of all four extremities, requiring fasciotomies. This is the first reported case of systemic capillary leak syndrome associated with COVID-19 infection. This case adds to the evolving spectrum of inflammatory effects associated with this viral infection.
Subject(s)
COVID-19/physiopathology , Capillary Leak Syndrome/physiopathology , Compartment Syndromes/physiopathology , Hypoalbuminemia/physiopathology , Shock/physiopathology , Abdominal Pain/etiology , Acidosis, Lactic/etiology , Acidosis, Lactic/physiopathology , Acidosis, Lactic/therapy , Acute Kidney Injury/etiology , Acute Kidney Injury/physiopathology , Acute Kidney Injury/therapy , COVID-19/complications , COVID-19/therapy , Capillary Leak Syndrome/etiology , Compartment Syndromes/etiology , Compartment Syndromes/surgery , Continuous Renal Replacement Therapy , Crystalloid Solutions/therapeutic use , Edema/etiology , Edema/physiopathology , Fasciotomy , Fatal Outcome , Fluid Therapy , Hematocrit , Humans , Hypoalbuminemia/etiology , Hypoalbuminemia/therapy , Male , Middle Aged , Respiration, Artificial , Rhabdomyolysis/etiology , Rhabdomyolysis/physiopathology , Shock/etiology , Shock/therapy , Tomography, X-Ray Computed , Vasoconstrictor Agents/therapeutic useABSTRACT
PURPOSE: Purpose of this report is to describe the feasibility of lingual pulse oximetry and lingual near-infrared spectroscopy (NIRS) in a COVID-19 patient to assess lingual tissue viability after several days of mechanical ventilation in the prone position. MATERIALS & METHODS: In a COVID-19 ICU-patient, the tongue became grotesquely swollen, hardened and protruding from the oral cavity after 20 h of mechanical ventilation uninterrupted in the prone position. To assess the doubtful viability of the tongue, pulse-oximetric hemoglobin O2-saturation (SpO2; Nellcor, OxiMax MAX-NI, Covidien, MA, USA) and NIRS-based, regional tissue O2-saturation measurements (rSO2; SenSmart, Nonin, MN, USA) were performed at the tongue. RESULTS: At the tongue, regular pulse-oximetric waveforms with a pulse-oximetric hemoglobin O2-saturation (SpO2) of 88% were recorded, i.e. only slightly lower than the SpO2 reading at the extremities at that time (90%). Lingual NIRS-based rSO2 measurements yielded stable tissue rSO2-values of 76-78%, i.e. values expected also in other adequately perfused and oxygenated (muscle-) tissues. CONCLUSION: Despite the alarming, clinical finding of a grotesquely swollen, rubber-hard tongue and clinical concerns on the adequacy of the tongue perfusion and oxygenation, our measurements of both arterial pulsatility (SpO2) and NIRS-based tissue oxygenation (rSO2) suggested adequate perfusion and oxygenation of the tongue, rendering non-vitality of the tongue, e.g. by lingual venous thrombosis, unlikely. To our knowledge, this is the first clinical report of lingual rSO2 measurement.