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1.
J Med Case Rep ; 15(1): 112, 2021 Mar 02.
Article in English | MEDLINE | ID: covidwho-1115251

ABSTRACT

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 infection can lead to a constellation of viral and immune symptoms called coronavirus disease 2019. Emerging literature increasingly supports the premise that severe acute respiratory syndrome coronavirus 2 promotes a prothrombotic milieu. However, to date there have been no reports of acute aortic occlusion, itself a rare phenomenon. We report a case of fatal acute aortic occlusion in a patient with coronavirus disease 2019. CASE REPORT: A 59-year-old Caucasian male with past medical history of peripheral vascular disease presented to the emergency department for evaluation of shortness of breath, fevers, and dry cough. His symptoms started 5-7 days prior to the emergency department visit, and he received antibiotics in the outpatient setting without any effect. He was found to be febrile, tachypneic, and hypoxemic. He was placed on supplemental oxygen via a non-rebreather mask. Chest X-ray showed multifocal opacifications. Intravenous antibiotics for possible pneumonia were initiated. Hydroxychloroquine was initiated to cover possible coronavirus disease 2019 pneumonia. During the hospitalization, the patient became progressively hypoxemic, for which he was placed on bilevel positive airway pressure. D-dimer, ferritin, lactate dehydrogenase, and C-reactive protein were all elevated. Severe acute respiratory syndrome coronavirus 2 reverse transcription polymerase chain reaction was positive. On day 3, the patient was upgraded to the intensive care unit. Soon after he was intubated, he developed a mottled appearance of skin, which extended from his bilateral feet up to the level of the subumbilical plane. Bedside ultrasound revealed an absence of flow from the mid-aorta to both common iliac arteries. The patient was evaluated emergently by vascular surgery. After a discussion with the family, it was decided to proceed with comfort-directed care, and the patient died later that day. DISCUSSION: Viral infections have been identified as a source of prothrombotic states due to direct injury of vascular tissue and inflammatory cascades. Severe acute respiratory syndrome coronavirus 2 appears to follow a similar pattern, with numerous institutions identifying elevated levels of thrombotic complications. We believe that healthcare providers should be aware of both venous and arterial thrombotic complications associated with coronavirus disease 2019, including possible fatal outcome.


Subject(s)
Aortic Diseases , Arterial Occlusive Diseases , SARS-CoV-2 , Thrombosis , Ultrasonography/methods , Aorta, Abdominal/diagnostic imaging , Aortic Diseases/diagnosis , Aortic Diseases/etiology , Aortic Diseases/physiopathology , Arterial Occlusive Diseases/diagnosis , Arterial Occlusive Diseases/etiology , Arterial Occlusive Diseases/physiopathology , Blood Coagulation , COVID-19/blood , COVID-19/complications , COVID-19/physiopathology , COVID-19/therapy , COVID-19 Nucleic Acid Testing/methods , Clinical Deterioration , Fatal Outcome , Humans , Male , Middle Aged , Patient Comfort , Point-of-Care Testing , SARS-CoV-2/isolation & purification , SARS-CoV-2/pathogenicity , Thrombosis/diagnostic imaging , Thrombosis/etiology , Thrombosis/physiopathology
2.
J Emerg Med ; 60(1): 103-106, 2021 01.
Article in English | MEDLINE | ID: covidwho-1065310

ABSTRACT

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 induces a marked prothrombotic state with varied clinical presentations, including acute coronary artery occlusions leading to ST-elevation myocardial infarction (STEMI). However, while STEMI on electrocardiogram (ECG) is not always associated with acute coronary occlusion, this diagnostic uncertainty should not delay cardiac catheterization. CASE REPORTS: We present 2 cases of patients with COVID-19 that presented with STEMI on ECG. While both patients underwent cardiac catheterization, a delay in time to intervention in the patient found to have acute coronary artery occlusion may have contributed to a poor outcome. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: These cases highlight the fact that while not all COVID-19 patients with STEMI on ECG will have acute coronary artery occlusions, there is continued need for prompt percutaneous coronary intervention during the severe acute respiratory syndrome coronavirus 2 pandemic.


Subject(s)
Diagnosis, Differential , ST Elevation Myocardial Infarction/diagnosis , Aged , COVID-19/physiopathology , COVID-19/prevention & control , Electrocardiography/methods , Humans , Male , Middle Aged , ST Elevation Myocardial Infarction/physiopathology
3.
CJC Open ; 3(2): 217-220, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1014407

ABSTRACT

We present the case of a patient with a nonbacterial thrombotic aortic valve endocarditis experiencing severe thromboembolic complications and an acute right internal carotid artery occlusion in the context of a paraneoplastic syndrome and an asymptomatic severe acute respiratory syndrome coronavirus-2 infection, despite treatment with different and overlapping anticoagulant medications. Patients with increased thrombogenicity due to an underlying disease might be at increased risk for thrombotic events during a severe acute respiratory syndrome coronavirus-2 infection.


Nous présentons le cas d'un patient atteint d'endocardite thrombotique non bactérienne de la valve aortique et présentant des complications thromboemboliques graves et une occlusion aiguë de la carotide interne droite dans le contexte d'un syndrome paranéoplasique et d'une infection à coronavirus du syndrome respiratoire aigu sévère 2 (SRAS-CoV-2) asymptomatique, malgré différentes anticoagulothérapies se chevauchant. Les patients présentant une thrombogénicité accrue en raison d'une affection sous-jacente pourraient courir un plus grand risque d'événement thrombotique en cas d'infection à SRAS-CoV-2.

4.
J Vasc Surg ; 73(1): 18-21, 2021 01.
Article in English | MEDLINE | ID: covidwho-963557

ABSTRACT

The severe acute respiratory syndrome novel coronavirus-2 pandemic is affecting almost every country in the world. Even if the major symptoms of coronavirus disease-2019 are respiratory, different symptoms at presentation are now recognized. Venous thromboembolism has been reported in infected patients and few but increasing cases of arterial thrombosis have been described. We report a case of acute aortoiliac and lower limb artery occlusions in a patient presenting with severe coronavirus disease-2019 infection. The mechanism of the occlusion seemed to be distal embolization from a floating thrombus in the aortic arch caused by a major inflammatory state and virus infection. The patient underwent aortoiliac and lower limb artery mechanical thrombectomy, but required unilateral major amputation.


Subject(s)
Aortic Diseases/etiology , Arterial Occlusive Diseases/etiology , COVID-19/complications , Iliac Artery , Thrombosis/etiology , Acute Disease , Amputation , Aortic Diseases/diagnostic imaging , Aortic Diseases/surgery , Arterial Occlusive Diseases/diagnostic imaging , Arterial Occlusive Diseases/surgery , COVID-19/diagnosis , COVID-19/therapy , Humans , Iliac Artery/diagnostic imaging , Iliac Artery/surgery , Male , Middle Aged , Thrombectomy , Thrombosis/diagnostic imaging , Thrombosis/surgery , Treatment Outcome
5.
Urologia ; 88(4): 386-388, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-947898

ABSTRACT

INTRODUCTION: Spontaneous rupture of kidney may involve collecting system or parenchyma. Parenchymal rupture usually occurs in patients with renal cell carcinoma, angiomyolipoma, renal cysts, arteriovenous malformation or vascular diseases such as periarteritis nodosa. Collecting system rupture is usually a rare complication of obstructive urolithiasis. We describe the unusual cases of spontaneous kidney rupture in patients with acute urinary obstruction. CASE PRESENTATION: The case report describes the left parenchymal kidney explosion related to ipsilateral ureteral obstruction caused by a single ureteral stone. The patient reached our emergency department with acute left flank pain and massive haematuria. At the moment of admission, the patient was in stage III hypovolemic shock and had a lower haematocrit (haemoglobin = 4.9 g/dL). Despite blood transfusions, emergency surgical exploration, extrafascial nephrectomy and intensive support care, the patient died twelve hours after surgery. CONCLUSIONS: Parenchymal renal rupture can be a life-threatening emergency. Despite its rarity, in the differential diagnosis of acute abdomen, parenchymal renal rupture should always be considered in patients with abdominal pain and an anamnesis or history of urinary stones, pointing out the need of early diagnosis also in benign urological conditions.


Subject(s)
Kidney Diseases , Ureteral Calculi , Ureteral Obstruction , Explosions , Humans , Kidney , Ureteral Calculi/complications , Ureteral Calculi/surgery , Ureteral Obstruction/etiology , Ureteral Obstruction/surgery
6.
Ann Surg ; 272(2): e63-e65, 2020 08.
Article in English | MEDLINE | ID: covidwho-706917

ABSTRACT

BACKGROUND: A novel coronavirus (COVID-19) erupted in the latter part of 2019. The virus, SARS-CoV-2 can cause a range of symptoms ranging from mild through fulminant respiratory failure. Approximately 25% of hospitalized patients require admission to the intensive care unit, with the majority of those requiring mechanical ventilation. High density consolidations in the bronchial tree and in the pulmonary parenchyma have been described in the advanced phase of the disease. We noted a subset of patients who had a sudden, significant increase in peak airway, plateau and peak inspiratory pressures. Partial or complete ETT occlusion was noted to be the culprit in the majority of these patients. METHODS: With institutional IRB approval, we examined a subset of our mechanically ventilated COVID-19 patients. All of the patients were admitted to one of our COVID-19 ICUs. Each was staffed by a board certified intensivist. During multidisciplinary rounds, all arterial blood gas (ABG) results, ventilator settings and ventilator measurements are discussed and addressed. ARDSNet Protocols are employed. In patients with confirmed acute occlusion of the endotracheal tube (ETT), acute elevation in peak airway and peak inspiratory pressures are noted in conjunction with desaturation. Data was collected retrospectively and demographics, ventilatory settings and ABG results were recorded. RESULTS: Our team has observed impeded ventilation in intubated patients who are several days into the critical course. Pathologic evaluation of the removed endotracheal tube contents from one of our patients demonstrated a specimen consistent with sloughed tracheobronchial tissues and inflammatory cells in a background of dense mucin. Of 110 patients admitted to our adult COVID-19 ICUs, 28 patients required urgent exchange of their ETT. CONCLUSION: Caregivers need to be aware of this pathological finding, recognize, and to treat this aspect of the COVID-19 critical illness course, which is becoming more prevalent.


Subject(s)
Bronchi/injuries , Coronavirus Infections/therapy , Intubation, Intratracheal/adverse effects , Pneumonia, Viral/therapy , Respiration, Artificial/adverse effects , Trachea/injuries , Adult , Betacoronavirus , COVID-19 , Female , Humans , Intensive Care Units , Male , Pandemics , SARS-CoV-2
7.
Int J Surg Case Rep ; 71: 147-150, 2020.
Article in English | MEDLINE | ID: covidwho-232748

ABSTRACT

INTRODUCTION: The COVID-19 pandemic presents a unique global health challenge further complicating surgical management of COVID-19 positive patients due to a lack of published literature. CASE: Within we discuss a 48-year-old Chinese man, presenting with acute gastrointestinal obstruction due to sigmoid colonic mass. The patient was screened and tested positive for COVID 19 due to his employment in Wuhan, China at the COVID-19 pandemic epicenter. The patient was subsequently taken for open sigmoid colonic resection, however the case presented multiple challenges due to the patient's COVID-19 positive status. DISCUSSION: The challenges of surgical management of COVID-19 positive patients exist are four-fold. First the unknown efficacy of pre-surgical risk stratification in COVID-19 positive patients, second the risk of aerosolized COVID-19 transmission during intubation for surgery, third the risk of fecal COVID-19 transmission to surgical staff during large bowel resection, and fourth the post-operative challenges of caring for COVID-19 positive patients. CONCLUSION: Further research is needed into these topics, as well as the medical management of COVID-19 surgical patients.

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