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Evidence for a thromboembolic pathogenesis of lung cavitations in severely ill COVID-19 patients.
Kruse, Jan Matthias; Zickler, Daniel; Lüdemann, Willie M; Piper, Sophie K; Gotthardt, Inka; Ihlow, Jana; Greuel, Selina; Horst, David; Kahl, Andreas; Eckardt, Kai-Uwe; Elezkurtaj, Sefer.
  • Kruse JM; Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. jan-matthias.kruse@charite.de.
  • Zickler D; Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
  • Lüdemann WM; Institute of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
  • Piper SK; Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
  • Gotthardt I; Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
  • Ihlow J; Institute of Pathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
  • Greuel S; Institute of Pathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
  • Horst D; Institute of Pathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
  • Kahl A; Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
  • Eckardt KU; Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
  • Elezkurtaj S; Institute of Pathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany. sefer.elezkurtaj@charite.de.
Sci Rep ; 11(1): 16039, 2021 08 06.
Article in English | MEDLINE | ID: covidwho-1345587
ABSTRACT
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) induces lung injury of varying severity, potentially causing severe acute respiratory distress syndrome (ARDS). Pulmonary injury patterns in COVID-19 patients differ from those in patients with other causes of ARDS. We aimed to explore the frequency and pathogenesis of cavitary lung lesions in critically ill patients with COVID-19. Retrospective study in 39 critically ill adult patients hospitalized with severe acute respiratory syndrome coronavirus 2 including lung injury of varying severity in a tertiary care referral center during March and May 2020, Berlin/Germany. We observed lung cavitations in an unusually large proportion of 22/39 (56%) COVID-19 patients treated on intensive care units (ICU), including 3/5 patients without mechanical ventilation. Median interquartile range (IQR) time between onset of symptoms and ICU admission was 11.5 (6.25-17.75) days. In 15 patients, lung cavitations were already present on the first CT scan, performed after ICU admission; in seven patients they developed during a subsequent median (IQR) observation period of 48 (35-58) days. In seven patients we found at least one cavitation with a diameter > 2 cm (maximum 10 cm). Patients who developed cavitations were older and had a higher body mass index. Autopsy findings in three patients revealed that the cavitations reflected lung infarcts undergoing liquefaction, secondary to thrombotic pulmonary artery branch occlusions. Lung cavitations appear to be a frequent complication of severely ill COVID-19 patients, probably related to the prothrombotic state associated with COVID-19.
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Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Pulmonary Embolism / COVID-19 / Lung Subject: Pulmonary Embolism / COVID-19 / Lung Type of study: Etiology study / Observational study / Evidence synthesis / Risk factors Language: English Journal: Sci Rep Year: 2021

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Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Pulmonary Embolism / COVID-19 / Lung Subject: Pulmonary Embolism / COVID-19 / Lung Type of study: Etiology study / Observational study / Evidence synthesis / Risk factors Language: English Journal: Sci Rep Year: 2021
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