RESUMO
We report the first use of a single 100-mm long custom-made version of the Optimus-CVS® balloon-expandable PTFE-covered XXL (15-Zig) stent (AndraTec, GmbH) to eliminate sinus venosus defect left-to-right shunt and redirect anomalous right pulmonary veins blood flow through a new walled channel to the left atrium. Anatomical feasibility and strategy decision were guided by ex-vivo procedure simulation on the patient-specific 3D printed heart model and in-vivo balloon interrogation. Modified procedural and implantation techniques are detailed. Immediate and one-month follow-up showed excellent outcomes.
Assuntos
Cardiopatias Congênitas , Comunicação Interatrial , Veias Pulmonares , Malformações Vasculares , Drenagem , Humanos , Veias Pulmonares/anormalidades , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/cirurgia , Stents , Resultado do TratamentoRESUMO
Stroke is a common and devastating event and the majority of cases are caused by thromboembolism from the left atrium, left ventricle or left sided valves. This case report describes a case of embolic stroke with the origin of the thrombus from the left inferior pulmonary vein. The importance of this case is twofold. Firstly, it is the fourth case report of pulmonary venous thrombosis, a very rare condition, due to COVID-19 infection and secondly, it focuses attention on the fact that the left atrium is not the most proximal address of arterial thromboembolism-the pulmonary veins are. Thus, it is proposed that a thorough assessment of the pulmonary veins should be done in all cases of arterial thromboembolism.
Assuntos
COVID-19 , AVC Embólico , AVC Isquêmico , Embolia Pulmonar , Veias Pulmonares , Tromboembolia , Trombose Venosa , COVID-19/complicações , AVC Embólico/diagnóstico por imagem , AVC Embólico/etiologia , Humanos , Embolia Pulmonar/etiologia , Tromboembolia/complicações , Trombose Venosa/complicaçõesRESUMO
Research on COVID-19, the cause of a rapidly worsening pandemic, has led to the observation of laboratory derangements such as a propensity towards a hypercoagulable state. However, there are currently no reports on the incidence of pulmonary venous thrombosis in the setting of COVID-19. We report a case in which follow-up chest CT scans revealed an expansile filling defect in a branch of the right inferior pulmonary vein, which is consistent with pulmonary venous thrombosis. Our objective was to provide insight into an uncommon sequela of COVID-19 and consequently garner increased clinical suspicion for pulmonary VTE during hospitalization.
Assuntos
COVID-19/complicações , Veias Pulmonares , Trombose Venosa/diagnóstico , Trombose Venosa/virologia , Adulto , COVID-19/diagnóstico , COVID-19/terapia , Humanos , Masculino , Tomografia Computadorizada por Raios X , Trombose Venosa/terapiaRESUMO
Background: Establishing the diagnosis of COVID-19 and Pneumocystisjirovecii pulmonary coinfection is difficult due to clinical and radiological similarities that exist between the two disorders. For the moment, fungal coinfections are underestimated in COVID-19 patients. Case presentation: We report the case of a 52-year-old male patient, who presented to the emergency department for severe dyspnea and died 17 h later. The RT-PCR test performed at his admission was negative for SARS-CoV-2. Retesting of lung fragments collected during autopsy revealed a positive result for SARS-CoV-2. Histopathological examination showed preexisting lesions, due to comorbidities, as well as recent lesions: massive lung thromboses, alveolar exudate rich in foam cells, suprapleural and intra-alveolar Pneumocystisjirovecii cystic forms, and bilateral adrenal hemorrhage. Conclusion: COVID-19 and P.jirovecii coinfection should be considered, particularly in critically ill patients, and we recommend the systematic search for P. jirovecii in respiratory samples.
Assuntos
COVID-19/patologia , Pulmão/patologia , Pneumonia por Pneumocystis/patologia , Insuficiência Respiratória/patologia , Trombose/patologia , Injúria Renal Aguda/complicações , Insuficiência Hepática Crônica Agudizada/complicações , Doenças das Glândulas Suprarrenais/complicações , Doenças das Glândulas Suprarrenais/patologia , Autopsia , COVID-19/complicações , Coinfecção/patologia , Exsudatos e Transudatos , Evolução Fatal , Fibrose , Células Espumosas/patologia , Hemorragia/complicações , Hemorragia/patologia , Humanos , Hipertensão/complicações , Hepatopatias Alcoólicas/complicações , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/complicações , Pneumonia por Pneumocystis/complicações , Artéria Pulmonar/patologia , Veias Pulmonares/patologia , Insuficiência Respiratória/etiologia , SARS-CoV-2 , Trombose/etiologiaRESUMO
PURPOSE: The vascular enlargement (VE) pattern differs from previously described imaging patterns for pneumonia. This study aimed to investigate the incidence, computed tomography (CT) characteristics, and diagnostic value of the VE pattern in coronavirus disease 2019 (COVID-19). METHOD: The CT data of 106 patients with COVID-19 from January 19 to February 29, 2020, and 52 patients with influenza virus pneumonia (IVP) from January 2018 to February 2020 were retrospectively collected. The incidences of the VE pattern between the two groups were compared. The CT manifestations of COVID-19 were analyzed with a particular focus on the VE pattern's specific CT signs, dynamic changes, and relationships with lesion size and disease severity. RESULTS: Peripheral and multilobar ground-glass opacities (GGOs) or mixed GGOs with various sizes and morphologies were typical features of COVID-19 on initial CT. The VE pattern was more common in COVID-19 (88/106, 83.02 %) than in IVP (10/52, 19.23 %) on initial CT (P < 0.001). Three special VE-pattern-specific CT signs, including central vascular sign, ginkgo leaf sign, and comb sign, were identified. Four types of dynamic changes in the VE pattern were observed on initial and follow-up CT, which were closely associated with the evolution of lesions and the time interval from the onset of symptoms to initial CT scan. The VE pattern in COVID-19 was more commonly seen in larger lesions and patients with severe-critical type (all P < 0.001). CONCLUSIONS: The VE pattern is a valuable CT sign for differentiating COVID-19 from IVP, which correlates with more extensive or serious disease. A good understanding of the CT characteristics of the VE pattern may contribute to the early and accurate diagnosis of COVID-19 and prediction of the evolution of lesions.
Assuntos
COVID-19/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Pneumonia/diagnóstico por imagem , Artéria Pulmonar/patologia , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/patologia , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/patologia , Criança , Diagnóstico Diferencial , Feminino , Humanos , Influenza Humana/diagnóstico por imagem , Influenza Humana/patologia , Pulmão/irrigação sanguínea , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Pneumonia/patologia , Artéria Pulmonar/diagnóstico por imagem , Estudos Retrospectivos , SARS-CoV-2 , Adulto JovemRESUMO
OBJECTIVES: Ground-glass opacity and consolidation are recognized typical features of Coronavirus disease-19 (COVID-19) pneumonia on Chest CT, yet ancillary findings have not been fully described. We aimed to describe ancillary findings of COVID-19 pneumonia on CT, to define their prevalence, and investigate their association with clinical data. METHODS: We retrospectively reviewed our CT chest cases with coupled reverse transcriptase polymerase chain reaction (rt-PCR). Patients with negative rt-PCR or without admission chest CT were excluded. Ancillary findings included: vessel enlargement, subpleural curvilinear lines, dependent subpleural atelectasis, centrilobular solid nodules, pleural and/or pericardial effusions, enlarged mediastinal lymph nodes. Continuous data were expressed as median and 95% confidence interval (95% CI) and tested by Mann-Whitney U test. RESULTS: Ancillary findings were represented by 106/252 (42.1%, 36.1 to 48.2) vessel enlargement, 50/252 (19.8%, 15.4 to 25.2) subpleural curvilinear lines, 26/252 (10.1%, 7.1 to 14.7) dependent subpleural atelectasis, 15/252 (5.9%, 3.6 to 9.6) pleural effusion, 15/252 (5.9%, 3.6 to 9.6) mediastinal lymph nodes enlargement, 13/252 (5.2%, 3 to 8.6) centrilobular solid nodules, and 6/252 (2.4%, 1.1 to 5.1) pericardial effusion. Air space disease was more extensive in patients with vessel enlargement or centrilobular solid nodules (p < 0.001). Vessel enlargement was associated with longer history of fever (p = 0.035) and lower admission oxygen saturation (p = 0.014); dependent subpleural atelectasis with lower oxygen saturation (p < 0.001) and higher respiratory rate (p < 0.001); mediastinal lymph nodes with shorter history of cough (p = 0.046); centrilobular solid nodules with lower prevalence of cough (p = 0.023), lower oxygen saturation (p < 0.001), and higher respiratory rate (p = 0.032), and pericardial effusion with shorter history of cough (p = 0.015). Ancillary findings associated with longer hospital stay were subpleural curvilinear lines (p = 0.02), whereas centrilobular solid nodules were associated with higher rate of intensive care unit admission (p = 0.01). CONCLUSION: Typical high-resolution CT findings of COVID-19 pneumonia are frequently associated with ancillary findings that variably associate with disease extent, clinical parameters, and disease severity. ADVANCES IN KNOWLEDGE: Ancillary findings might reflect the broad range of heterogeneous mechanisms in severe acute respiratory syndrome from viral pneumonia, and potentially help disease phenotyping.
Assuntos
COVID-19/diagnóstico por imagem , Achados Incidentais , Pulmão/diagnóstico por imagem , SARS-CoV-2 , Adulto , Idoso , Idoso de 80 Anos ou mais , Dilatação Patológica/diagnóstico por imagem , Feminino , Humanos , Pulmão/irrigação sanguínea , Linfonodos/diagnóstico por imagem , Linfadenopatia/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores/métodos , Variações Dependentes do Observador , Derrame Pleural/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Veias Pulmonares/diagnóstico por imagem , Estudos RetrospectivosRESUMO
Hereditary haemorrhagic telangiectasia (HHT) also known as Osler-Weber-Rendu syndrome is an autosomal dominant disorder affecting 1 in 8000 individuals. The eponym recognises the 19th-century physicians William Osler, Henri Jules Louis Marie Rendu and Frederick Parkes Weber who each independently described the disease. It is characterised by epistaxis, telangiectasia and visceral arteriovenous malformations. Individuals with HHT have been found to have abnormal plasma concentrations of transforming growth factor beta and vascular endothelial growth factor secondary to mutations in ENG, ACVRL1 and MADH4. Pulmonary artery malformations (PAVMs) are abnormal communications between pulmonary arteries and veins and are found in up to 50% of individuals with HHT. The clinical features suggestive of PAVMs are stigmata of right to left shunting such as dyspnoea, hypoxaemia, cyanosis, cerebral embolism and unexplained haemoptysis or haemothorax. The authors present the case of a 33-year-old woman presenting with progressive dyspnoea during the COVID-19 pandemic. She had a typical presentation of HHT with recurrent epistaxis, telangiectasia and pulmonary arteriovenous malformations. Although rare, PAVM should be considered in individuals presenting to the emergency department with dyspnoea and hypoxaemia. Delayed diagnosis can result in fatal embolic and haemorrhagic complications.
Assuntos
Malformações Arteriovenosas/diagnóstico , Dispneia/fisiopatologia , Epistaxe/fisiopatologia , Hipóxia/fisiopatologia , Telangiectasia Hemorrágica Hereditária/diagnóstico , Receptores de Activinas Tipo II/genética , Adulto , Antitireóideos/uso terapêutico , Malformações Arteriovenosas/fisiopatologia , Gasometria , COVID-19/diagnóstico , Carbimazol/uso terapêutico , Diagnóstico Diferencial , Feminino , Doença de Graves/complicações , Doença de Graves/tratamento farmacológico , Humanos , Transtornos de Enxaqueca/complicações , Artéria Pulmonar/anormalidades , Artéria Pulmonar/diagnóstico por imagem , Veias Pulmonares/anormalidades , Veias Pulmonares/diagnóstico por imagem , SARS-CoV-2 , Telangiectasia Hemorrágica Hereditária/complicações , Telangiectasia Hemorrágica Hereditária/fisiopatologia , Tomografia Computadorizada por Raios XAssuntos
COVID-19/complicações , Fibrinolíticos/uso terapêutico , Artéria Pulmonar , Veias Pulmonares , SARS-CoV-2 , Estreptoquinase/uso terapêutico , Terapia Trombolítica , Trombose/tratamento farmacológico , Idoso , Anticorpos Monoclonais Humanizados/uso terapêutico , COVID-19/sangue , COVID-19/terapia , Coinfecção , Terapia Combinada , Feminino , Hemorragia/induzido quimicamente , Humanos , Hipóxia/etiologia , Pneumopatias Fúngicas/complicações , Pneumopatias Fúngicas/terapia , Masculino , Pessoa de Meia-Idade , Pneumonia Bacteriana/complicações , Pneumonia Bacteriana/terapia , Proteínas Recombinantes/efeitos adversos , Proteínas Recombinantes/uso terapêutico , Respiração Artificial , Estreptoquinase/efeitos adversos , Trombofilia/etiologia , Trombose/etiologiaAssuntos
Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Veias Pulmonares , Trombose/virologia , Betacoronavirus , COVID-19 , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Pessoa de Meia-Idade , Pandemias , Insuficiência Respiratória/virologia , SARS-CoV-2 , Trombose/diagnóstico por imagemAssuntos
Betacoronavirus , Infecções por Coronavirus/sangue , Pulmão/patologia , Megacariócitos/patologia , Pandemias , Pneumonia Viral/sangue , Fibrose Pulmonar/etiologia , Veias Pulmonares , Trombofilia/etiologia , Trombose Venosa/etiologia , Plaquetas/fisiologia , COVID-19 , Infecções por Coronavirus/complicações , Infecções por Coronavirus/patologia , Humanos , Megacariócitos/fisiologia , Neovascularização Patológica/etiologia , Neovascularização Patológica/patologia , Pneumonia Viral/complicações , Pneumonia Viral/patologia , Pseudópodes/patologia , Fibrose Pulmonar/patologia , Síndrome do Desconforto Respiratório/sangue , Síndrome do Desconforto Respiratório/etiologia , SARS-CoV-2 , Trombofilia/sangue , Trombopoese , Trombose Venosa/patologiaAssuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Embolia Pulmonar/diagnóstico , Microangiopatias Trombóticas/etiologia , Trombose Venosa/etiologia , Lesão Pulmonar Aguda/etiologia , Lesão Pulmonar Aguda/fisiopatologia , Coagulação Sanguínea , COVID-19 , Infecções por Coronavirus/sangue , Diagnóstico Diferencial , Humanos , Pandemias , Pneumonia Viral/sangue , Veias Pulmonares , SARS-CoV-2 , Microangiopatias Trombóticas/diagnóstico , Microangiopatias Trombóticas/fisiopatologia , Trombose Venosa/diagnóstico , Trombose Venosa/epidemiologia , Trombose Venosa/fisiopatologiaRESUMO
This practical guidance, endorsed by the Brazilian Society of Thrombosis and Hemostasis and The Brazilian Society of Angiology and Vascular Surgery, the International Union of Angiology and the European Venous Forum, aims to provide physicians with clear guidance, based on current best evidence-based data, on clinical strategies to manage antithrombotic strategies in patients with coronavirus disease 2019.