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1.
Clin Radiol ; 77(2): 148-155, 2022 02.
Article in English | MEDLINE | ID: covidwho-1611681

ABSTRACT

AIM: To determine if there is a difference in radiological, biochemical, or clinical severity between patients infected with Alpha-variant SARS-CoV-2 compared with those infected with pre-existing strains, and to determine if the computed tomography (CT) severity score (CTSS) for COVID-19 pneumonitis correlates with clinical severity and can prognosticate outcomes. MATERIALS AND METHODS: Blinded CTSS scoring was applied to 137 hospital patients who had undergone both CT pulmonary angiography (CTPA) and whole-genome sequencing of SARS-CoV-2 within 14 days of CTPA between 1/12/20-5/1/21. RESULTS: There was no evidence of a difference in imaging severity on CTPA, viral load, clinical parameters of severity, or outcomes between Alpha and preceding variants. CTSS on CTPA strongly correlates with clinical and biochemical severity at the time of CTPA, and with patient outcomes. Classifying CTSS into a binary value of "high" and "low", with a cut-off score of 14, patients with a high score have a significantly increased risk of deterioration, as defined by subsequent admission to critical care or death (multivariate hazard ratio [HR] 2.76, p<0.001), and hospital length of stay (17.4 versus 7.9 days, p<0.0001). CONCLUSION: There was no evidence of a difference in radiological severity of Alpha variant infection compared with pre-existing strains. High CTSS applied to CTPA is associated with increased risk of COVID-19 severity and poorer clinical outcomes and may be of use particularly in settings where CT is not performed for diagnosis of COVID-19 but rather is used following clinical deterioration.


Subject(s)
COVID-19/diagnostic imaging , Computed Tomography Angiography , SARS-CoV-2/genetics , Severity of Illness Index , Whole Genome Sequencing , Aged , COVID-19/mortality , COVID-19/virology , Cohort Studies , Critical Care , Female , Humans , Length of Stay , Male , Middle Aged , Retrospective Studies , Time Factors , United Kingdom , Viral Load
5.
Medicine (Baltimore) ; 99(26): e20991, 2020 Jun 26.
Article in English | MEDLINE | ID: covidwho-1455401

ABSTRACT

RATIONALE: Pial arteriovenous fistula (PAVF) occurs when intracranial arteries communicate directly with veins. PAVFs are very rare congenital vascular lesions that are commonly seen in infants and children. Arachnoid cysts are congenital cavitation often filled with cerebrospinal fluid. We present a very rare associated occurrence of bilateral pediatric PAVF and a giant arachnoid cyst presenting as torticollis in a child. So far, this is the first case. PATIENT CONCERNS: A 6-year-old male child was referred to our facility from a local hospital due to severe torticollis. DIAGNOSES: An enhanced computed tomography scan revealed 2 slightly high-density masses at the anterior pontine cistern, right circumferential cistern, as well as left posterior occipital region. The same computed tomography scan revealed a giant arachnoid cyst in the left occipital as well as the temporal region with a thin cerebral cortex adjacent to the cyst. INTERVENTIONS: Digital subtraction angiography confirmed that the 2 high-flow lesions were PAVFs. The patient was treated with a combination of detachable coils and Onyx Liquid Embolic System (Onyx HD-500) (Covidien/ev3 Neurovascular) via the transarterial endovascular route while the giant arachnoid cyst was managed conservatively. OUTCOMES: The torticollis resolved 2 days after the procedure. He is currently well with no neurologic deficit. LESSONS: We advocate that in cases of PAVF with accompanying cyst, the cyst should be managed conservatively if it is not associated with intracranial hemorrhage or focal neurologic deficit.


Subject(s)
Arteriovenous Fistula/diagnosis , Cerebral Veins/abnormalities , Arachnoid Cysts , Arteriovenous Malformations/complications , Arteriovenous Malformations/surgery , Child , Computed Tomography Angiography/methods , Humans , Male , Torticollis/etiology
6.
Heart ; 108(1): 46-53, 2022 01.
Article in English | MEDLINE | ID: covidwho-1455729

ABSTRACT

OBJECTIVES: To determine the contribution of comorbidities on the reported widespread myocardial abnormalities in patients with recent COVID-19. METHODS: In a prospective two-centre observational study, patients hospitalised with confirmed COVID-19 underwent gadolinium and manganese-enhanced MRI and CT coronary angiography (CTCA). They were compared with healthy and comorbidity-matched volunteers after blinded analysis. RESULTS: In 52 patients (median age: 54 (IQR 51-57) years, 39 males) who recovered from COVID-19, one-third (n=15, 29%) were admitted to intensive care and a fifth (n=11, 21%) were ventilated. Twenty-three patients underwent CTCA, with one-third having underlying coronary artery disease (n=8, 35%). Compared with younger healthy volunteers (n=10), patients demonstrated reduced left (ejection fraction (EF): 57.4±11.1 (95% CI 54.0 to 60.1) versus 66.3±5 (95 CI 62.4 to 69.8)%; p=0.02) and right (EF: 51.7±9.1 (95% CI 53.9 to 60.1) vs 60.5±4.9 (95% CI 57.1 to 63.2)%; p≤0.0001) ventricular systolic function with elevated native T1 values (1225±46 (95% CI 1205 to 1240) vs 1197±30 (95% CI 1178 to 1216) ms;p=0.04) and extracellular volume fraction (ECV) (31±4 (95% CI 29.6 to 32.1) vs 24±3 (95% CI 22.4 to 26.4)%; p<0.0003) but reduced myocardial manganese uptake (6.9±0.9 (95% CI 6.5 to 7.3) vs 7.9±1.2 (95% CI 7.4 to 8.5) mL/100 g/min; p=0.01). Compared with comorbidity-matched volunteers (n=26), patients had preserved left ventricular function but reduced right ventricular systolic function (EF: 51.7±9.1 (95% CI 53.9 to 60.1) vs 59.3±4.9 (95% CI 51.0 to 66.5)%; p=0.0005) with comparable native T1 values (1225±46 (95% CI 1205 to 1240) vs 1227±51 (95% CI 1208 to 1246) ms; p=0.99), ECV (31±4 (95% CI 29.6 to 32.1) vs 29±5 (95% CI 27.0 to 31.2)%; p=0.35), presence of late gadolinium enhancement and manganese uptake. These findings remained irrespective of COVID-19 disease severity, presence of myocardial injury or ongoing symptoms. CONCLUSIONS: Patients demonstrate right but not left ventricular dysfunction. Previous reports of left ventricular myocardial abnormalities following COVID-19 may reflect pre-existing comorbidities. TRIAL REGISTRATION NUMBER: NCT04625075.


Subject(s)
COVID-19 , Ventricular Dysfunction, Right/diagnostic imaging , Adult , Computed Tomography Angiography , Contrast Media , Coronary Angiography , Female , Humans , Magnetic Resonance Imaging, Cine , Male , Manganese/metabolism , Matched-Pair Analysis , Middle Aged , Myocardium/metabolism , Prospective Studies , Survivors , Systole/physiology , Ventricular Dysfunction, Right/physiopathology
7.
Hamostaseologie ; 41(5): 400-402, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1397934

ABSTRACT

In this case report we present a previously healthy 21-year-old male with extensive thromboembolism in the setting of asymptomatic COVID-19 infection and heterozygous factor V Leiden mutation with no additional thrombophilic risk factors.


Subject(s)
COVID-19/complications , Factor V/genetics , SARS-CoV-2 , Thromboembolism/complications , Thromboembolism/genetics , Asymptomatic Infections , COVID-19/diagnosis , COVID-19/diagnostic imaging , Computed Tomography Angiography , Heterozygote , Humans , Male , Thromboembolism/therapy , Young Adult
11.
Int J Infect Dis ; 111: 154-163, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1364097

ABSTRACT

PURPOSE: To detect the risk factors for pulmonary embolism (PE) in patients with COVID-19. METHODS: Studies were searched for in PubMed, Cochrane Library, Web of Science, and EMBASE. Two authors independently screened articles and extracted data. The data were pooled by meta-analysis and three subgroup analyses were performed. RESULTS: Of the 2210 articles identified, 27 studies were included. Pooled analysis suggested that males (odds ratio (OR) 1.49, 95% confidence interval (CI) 1.26-1.75, P = 0.000), obesity (OR 1.37, 95% CI 1.03-1.82, P = 0.033), mechanical ventilation (OR 3.34, 95% CI 1.90-5.86, P = 0.000), severe parenchymal abnormalities (OR 1.92, 95% CI 1.43-2.58, P = 0.000), ICU admission (OR 2.44, 95% CI 1.48-4.03, P = 0.000), and elevated D-dimer and white blood cell values (at two time points: hospital admission or closest to computed tomography pulmonary angiography) (P = 0.000) correlated with a risk for PE occurrence in COVID-19 patients. However, age and common comorbidities had no association with PE occurrence. Computed tomography pulmonary angiography, unclear-ratio/low-ratio, and hospitalization subgroups had consistent risk factors with all studies; however, other subgroups had fewer risk factors for PE. CONCLUSIONS: Risk factors for PE in COVID-19 were different from the classic risk factors for PE and are likely to differ in diverse study populations.


Subject(s)
COVID-19 , Pulmonary Embolism , Computed Tomography Angiography , Humans , Male , Pulmonary Embolism/epidemiology , Pulmonary Embolism/etiology , Risk Factors , SARS-CoV-2
12.
Thromb Res ; 206: 29-32, 2021 10.
Article in English | MEDLINE | ID: covidwho-1347837

ABSTRACT

BACKGROUND: COVID-19 is still a global challenge in regard for management and therapy. Pulmonary embolism (PE) seems to have a higher prevalence in COVID-19 instead of non-COVID patients. Clinical and laboratory parameters related with PE are still unknown. METHODS: We conducted a retrospective unicentre study in Alto Vicentino Hospital between March 1st, 2020, and January 31st, 2021 in patients admitted for COVID-19 tested with a RT-PCR nasal swab. Data about patients studied with computed tomography pulmonary angiogram (CTPA) because of PE suspicion were collected, as their clinical and laboratory parameters too. RESULTS: 2621 patients were admitted for COVID-19 in Alto Vicentino Hospital between March 1st, 2020, and January 31st, 2021 and in 267 of them a CTPA was performed finding 50 PE (18.7%). Only non-Caucasian race (OR = 5.44; 95% CI 1.22-24.35; p = 0.027) and previous VTE (OR = 5.3; 95% CI 1.09-26.17; p = 0.039) were found to be independently associated with PE. CONCLUSION: PE is a frequent complication of COVID-19 and clinician need high degree of suspicion because clinical and laboratoristic parameters cannot drive diagnosis.


Subject(s)
COVID-19 , Pulmonary Embolism , Computed Tomography Angiography , Humans , Pulmonary Embolism/diagnosis , Retrospective Studies , SARS-CoV-2
13.
Nat Commun ; 12(1): 4663, 2021 08 02.
Article in English | MEDLINE | ID: covidwho-1338537

ABSTRACT

Vaccine-induced thrombotic thrombocytopenia with cerebral venous thrombosis is a syndrome recently described in young adults within two weeks from the first dose of the ChAdOx1 nCoV-19 vaccine. Here we report two cases of malignant middle cerebral artery (MCA) infarct and thrombocytopenia 9-10 days following ChAdOx1 nCoV-19 vaccination. The two cases arrived in our facility around the same time but from different geographical areas, potentially excluding epidemiological links; meanwhile, no abnormality was found in the respective vaccine batches. Patient 1 was a 57-year-old woman who underwent decompressive craniectomy despite two prior, successful mechanical thrombectomies. Patient 2 was a 55-year-old woman who developed a fatal bilateral malignant MCA infarct. Both patients manifested pulmonary and portal vein thrombosis and high level of antibodies to platelet factor 4-polyanion complexes. None of the patients had ever received heparin in the past before stroke onset. Our observations of rare arterial thrombosis may contribute to assessment of possible adverse effects associated with COVID-19 vaccination.


Subject(s)
COVID-19 Vaccines/adverse effects , COVID-19/immunology , Cerebral Infarction/chemically induced , Purpura, Thrombocytopenic, Idiopathic/chemically induced , SARS-CoV-2/immunology , Thrombosis/chemically induced , Autoantibodies/blood , Autoantibodies/immunology , COVID-19/virology , COVID-19 Vaccines/administration & dosage , COVID-19 Vaccines/immunology , Cerebral Infarction/diagnostic imaging , Computed Tomography Angiography/methods , Female , Humans , Magnetic Resonance Imaging/methods , Middle Aged , Platelet Factor 4/immunology , Purpura, Thrombocytopenic, Idiopathic/diagnostic imaging , SARS-CoV-2/physiology , Thrombosis/diagnostic imaging , Tomography, X-Ray Computed/methods , Vaccination/adverse effects , Venous Thrombosis/chemically induced , Venous Thrombosis/diagnostic imaging
16.
Int J Environ Res Public Health ; 18(14)2021 Jul 18.
Article in English | MEDLINE | ID: covidwho-1314662

ABSTRACT

OBJECTIVES: Patients with COVID-19 may be at high risk for thrombotic complications due to excess inflammatory response and stasis of blood flow. This study aims to assess the incidence of pulmonary embolism among hospitalized patients with COVID-19, risk factors, and the impact on survival. METHODS: A retrospective case-control study was conducted at Al-Noor Specialist Hospital in Saudi Arabia between 15 March 2020 and 15 June 2020. Patients with confirmed COVID-19 diagnosis by a real-time polymerase chain reaction (PCR) and confirmed diagnosis of pulmonary embolism by Computed Tomography pulmonary angiogram (CTPA) formed the case group. Patients with confirmed COVID-19 diagnosis by a real-time polymerase chain reaction (PCR) and without confirmed diagnose of pulmonary embolism formed the control group. Logistic regression analysis was used to identify predictors of pulmonary embolism and survival. RESULTS: A total of 159 patients participated were included in the study, of which 51 were the cases (patients with pulmonary embolism) and 108 patients formed the control group (patients without pulmonary embolism). The incidence of PE among those hospitalized was around 32%. Smoking history, low level of oxygen saturation, and higher D-dimer values were important risk factors that were associated with a higher risk of developing PE (p < 0.05). Higher respiratory rate was associated with higher odds of death, and decreased the possibility of survival among hospitalized patients with PE. CONCLUSIONS: Pulmonary embolism is common among hospitalized patients with COVID-19. Preventive measures should be considered for hospitalized patients with smoking history, low level of oxygen saturation, high D-dimer values, and high respiratory rate.


Subject(s)
COVID-19 , Pulmonary Embolism , COVID-19 Testing , Case-Control Studies , Computed Tomography Angiography , Humans , Incidence , Pulmonary Embolism/epidemiology , Retrospective Studies , SARS-CoV-2 , Saudi Arabia/epidemiology
17.
J Thromb Thrombolysis ; 52(1): 76-84, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1310591

ABSTRACT

Subpleural consolidations have been found in lung ultrasound in patients with COVID-19, possibly deriving from pulmonary embolism (PE). The diagnostic utility of impact of lung ultrasound in critical-ill patients with COVID-19 for PE diagnostics however is unclear. We retrospectively evaluated all SARS-CoV2-associated ARDS patients admitted to our ICU between March 8th and May 31th 2020. They were enrolled in this study, when a lung ultrasound and a computed tomography pulmonary angiography (CTPA) were documented. In addition, wells score was calculated to estimate the probability of PE. The CTPA was used as the gold standard for the detection of PE. Twenty out of 25 patients met the inclusion criteria. In 12/20 patients (60%) (sub-) segmental PE were detected by CT-angiography. Lung ultrasound found subpleural consolidations in 90% of patients. PE-typical large supleural consolidations with a size ≥ 1 cm were detectable in 65% of patients and were significant more frequent in patients with PE compared to those without (p = 0.035). Large consolidations predicted PE with a sensitivity of 77% and a specificity of 71%. The Wells score was significantly higher in patients with PE compared to those without (2.7 ± 0.8 and 1.7 ± 0.5, respectively, p = 0.042) and predicted PE with an AUC of 0.81. When combining the two modalities, comparing patients with considered/probable PE using LUS plus a Wells score ≥ 2 to patients with possible/unlikely PE in LUS plus a Wells score < 2, PE could be predicted with a sensitivity of 100% and a specificity of 80%. Large consolidations detected in lung ultrasound were found frequently in COVID-19 ARDS patients with pulmonary embolism. In combination with a Wells score > 2, this might indicate a high-risk for PE in COVID-19.


Subject(s)
COVID-19/complications , Clinical Decision Rules , Computed Tomography Angiography , Lung/diagnostic imaging , Pulmonary Artery/diagnostic imaging , Pulmonary Embolism/diagnostic imaging , Ultrasonography , Aged , COVID-19/diagnosis , Critical Illness , Female , Humans , Male , Middle Aged , Multimodal Imaging , Predictive Value of Tests , Pulmonary Embolism/etiology , Registries , Reproducibility of Results , Retrospective Studies , Risk Assessment , Risk Factors
18.
Am J Med Sci ; 362(4): 418-423, 2021 10.
Article in English | MEDLINE | ID: covidwho-1275105

ABSTRACT

Coronavirus disease 2019 (COVID-19) has been associated with an increased risk of venous and arterial thrombotic disease. Although pulmonary embolism has been the most common thrombotic complication, there have been recent reports of COVID-19-associated large-vessel ischemic stroke, acute upper- and lower-limb ischemia, as well as infarctions of the abdominal viscera, including renal, splenic, and small bowel infarctions. Here, we describe a case of splenic infarction (SI) associated with aortic thrombosis, which evolved despite the prophylactic use of low-molecular-weight heparin (LMWH), in a 60-year-old female patient with COVID-19. The patient was treated clinically with a therapeutic dose of LMWH, followed by warfarin, and eventually presented a favorable outcome. We also present a review of the literature regarding SI in patients with COVID-19.


Subject(s)
Aortic Diseases/virology , COVID-19/complications , Splenic Infarction/virology , Thrombosis/virology , COVID-19/diagnostic imaging , Computed Tomography Angiography , Female , Humans , Middle Aged , Splenic Infarction/diagnostic imaging
19.
Jt Dis Relat Surg ; 32(2): 551-555, 2021.
Article in English | MEDLINE | ID: covidwho-1279005

ABSTRACT

Although novel coronavirus-2019 (COVID-19) primarily affects the respiratory system, it can affect multiple organ systems, leading to serious complications, such as acute respiratory distress syndrome (ARDS) and multiple organ failure. Nearly 20 to 55% of patients with COVID-19 experience coagulation disorders that cause high mortality in line with the severity of the clinical picture. Thromboembolism can be observed in both venous and arterial systems. The vast majority of thromboembolic events are associated with the venous system and are often observed as pulmonary embolism. Arterial thromboembolisms often involve the arteries in the lower extremities, followed by those in the upper extremities. Herein, we report a rare case of COVID-19 pneumonia whose left arm was amputated at the forearm level after arterial thromboembolism in the left upper extremity. This case report is valuable, as it is the first reported case of upper extremity arterial thromboembolism in Turkey, as well as the only case in the literature in which the patient underwent four surgical interventions and is still alive.


Subject(s)
Amputation/methods , Brachial Artery , COVID-19 , Reoperation/methods , Thrombectomy , Thromboembolism , Upper Extremity , Aged , Brachial Artery/diagnostic imaging , Brachial Artery/pathology , COVID-19/blood , COVID-19/complications , COVID-19/diagnosis , COVID-19/therapy , Computed Tomography Angiography/methods , Humans , Male , Recurrence , SARS-CoV-2/isolation & purification , Severity of Illness Index , Thrombectomy/adverse effects , Thrombectomy/methods , Thromboembolism/complications , Thromboembolism/diagnosis , Thromboembolism/etiology , Treatment Outcome , Upper Extremity/blood supply , Upper Extremity/pathology , Upper Extremity/surgery
20.
Abdom Radiol (NY) ; 46(7): 3490-3500, 2021 07.
Article in English | MEDLINE | ID: covidwho-1265491

ABSTRACT

PURPOSE: To assess the spectrum of computed tomography angiogram (CTA) abdominal and pelvic findings in critically ill COVID-19 patients and investigate correlation with CT chest scores. METHODS: An IRB approved retrospective study of CTA of the chest, abdomen and pelvis between dates March 1st to September 15th, 2020 was performed in the hospitalized COVID-19 positive patients. CTA studies of solely the chest were excluded. Medical record review was performed to note patient demographics, CTA scan details and coagulation profile. CTA findings were reviewed to record vascular and non-vascular findings. CT chest was reviewed to calculate CT chest score. Logistic regression analyses were performed to correlate CT chest scores with odds of vascular and other abdomen-pelvis findings. A p < 0.05 was considered statistically significant. RESULTS: A total of 45 consecutive hospitalized COVID-19 positive patients with 61 years mean age and M:F (2:1) gender ratio were evaluated, out of which majority 68.9% (n = 31) had CTA chest, abdomen and pelvis. The most common vascular findings were hematoma 46.7% (n = 21), active extravasation 24.4% (n = 11) and vascular occlusion 17.8% (n = 8). Higher CT chest scores were significantly associated with hematoma/extravasation (OR 1.19, 95% CI 1.07-1.34, p < 0.01). The most common non-vascular abdomen-pelvis findings were seen in organs gallbladder 20% (n = 9), liver 20% (n = 9) followed by kidney 15.6% (n = 7). Higher CT chest scores were significantly associated with bowel findings (OR 1.28, 95% CI 1.01-1.63, p < 0.05) and cholestasis (OR 13.3, 95% CI 1.28-138.9, p < 0.05). CONCLUSION: Patients with moderate to severe COVID-19 pneumonia have significantly higher rate of vascular complications in the abdomen and pelvis.


Subject(s)
COVID-19 , Abdomen/diagnostic imaging , Computed Tomography Angiography , Critical Illness , Humans , Pelvis/diagnostic imaging , Retrospective Studies , SARS-CoV-2 , Tomography, X-Ray Computed
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