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Saddle pulmonary embolism and clot in transit in COVID-19 infection: a case report of catastrophic venous thromboembolism.
Aoi, Shunsuke; Kakkar, Amit M; Golowa, Yosef; Grushko, Michael; Coyle, Christina M; Elrafei, Tarek; Langston, Matthew D; Faillace, Robert T; Bangalore, Sripal; Sokol, Seth I.
  • Aoi S; Department of Medicine/Cardiology, New York City Health + Hospitals Corporation, Jacobi Medical Center 1400 Pelham Parkway, Bronx, NY 10461, USA.
  • Kakkar AM; Department of Medicine/Cardiology, New York City Health + Hospitals Corporation, Jacobi Medical Center 1400 Pelham Parkway, Bronx, NY 10461, USA.
  • Golowa Y; Department of Radiology, Montefiore Medical Center 111 E 210th St, Bronx, NY 10467, USA.
  • Grushko M; Department of Medicine/Cardiology, New York City Health + Hospitals Corporation, Jacobi Medical Center 1400 Pelham Parkway, Bronx, NY 10461, USA.
  • Coyle CM; Department of Medicine/Infectious Disease, New York City Health + Hospitals Corporation, Jacobi Medical Center 1400 Pelham Parkway, Bronx, NY 10461, USA.
  • Elrafei T; Department of Medicine/Hematology Oncology, New York City Health + Hospitals Corporation, Jacobi Medical Center 1400 Pelham Parkway, Bronx, NY 10461, USA.
  • Langston MD; Department of Medicine/Pulmonary and Critical Care, New York City Health + Hospitals Corporation, Jacobi Medical Center 1400 Pelham Parkway, Bronx, NY 10461, USA.
  • Faillace RT; Department of Medicine/Cardiology, New York City Health + Hospitals Corporation, Jacobi Medical Center 1400 Pelham Parkway, Bronx, NY 10461, USA.
  • Bangalore S; Department of Medicine, New York University Grossman School of Medicine 550 First Avenue, New York, NY 10016, USA.
  • Sokol SI; Department of Medicine/Cardiology, New York City Health + Hospitals Corporation, Jacobi Medical Center 1400 Pelham Parkway, Bronx, NY 10461, USA.
Eur Heart J Case Rep ; 4(6): 1-6, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1236227
ABSTRACT

BACKGROUND:

Coronavirus disease 2019 (COVID-19) is associated with a coagulopathy favouring thrombosis over bleeding that imparts a poor prognosis. Clot in transit (CIT) is considered a rare entity and the most severe form of venous thromboembolism (VTE), carrying a higher mortality than isolated pulmonary embolism (PE). The incidence of this phenomenon in patients with COVID-19 infection is unknown and likely under-recognized. CASE

SUMMARY:

During the peak of the COVID-19 pandemic in New York City, a 70-year-old Hispanic female presented with syncope due to a saddle PE further complicated by a highly mobile CIT. Polymerase chain reaction was positive for COVID-19 infection, however, there was no evidence of lung parenchymal involvement or hyper-inflammation. Based on consensus from a multidisciplinary team, aspiration thrombectomy was attempted to treat this extreme case of VTE, however, the patient died during the procedure.

DISCUSSION:

This case raises awareness to the most catastrophic form of VTE, presenting in an early phase of COVID-19 infection without the typical hyper-inflammation and severe lung injury associated with development of COVID-related coagulopathy. It also serves to inform on the critical role echocardiography has in the comprehensive evaluation and re-evaluation of hospitalized patients with COVID-19, and the importance of a multidisciplinary organized approach in clinical decision-making for this complex and poorly understood disease and its sequelae.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Case report / Experimental Studies / Observational study / Prognostic study Topics: Long Covid Language: English Journal: Eur Heart J Case Rep Year: 2020 Document Type: Article Affiliation country: Ehjcr

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Case report / Experimental Studies / Observational study / Prognostic study Topics: Long Covid Language: English Journal: Eur Heart J Case Rep Year: 2020 Document Type: Article Affiliation country: Ehjcr