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Pulmonary artery thrombi are co-located with opacifications in SARS-CoV2 induced ARDS.
Mueller-Peltzer, Katharina; Krauss, Tobias; Benndorf, Matthias; Lang, Corinna N; Bamberg, Fabian; Bode, Christoph; Duerschmied, Daniel; Staudacher, Dawid L; Zotzmann, Viviane.
  • Mueller-Peltzer K; Department of Diagnostic and Interventional Radiology, Faculty of Medicine, University of Freiburg, Germany.
  • Krauss T; Department of Diagnostic and Interventional Radiology, Faculty of Medicine, University of Freiburg, Germany.
  • Benndorf M; Department of Diagnostic and Interventional Radiology, Faculty of Medicine, University of Freiburg, Germany.
  • Lang CN; Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Germany; Department of Medicine III (Interdisciplinary Internal Medicine Intensive Care), Faculty of Medicine, University of Freiburg, Germany.
  • Bamberg F; Department of Diagnostic and Interventional Radiology, Faculty of Medicine, University of Freiburg, Germany.
  • Bode C; Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Germany; Department of Medicine III (Interdisciplinary Internal Medicine Intensive Care), Faculty of Medicine, University of Freiburg, Germany.
  • Duerschmied D; Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Germany; Department of Medicine III (Interdisciplinary Internal Medicine Intensive Care), Faculty of Medicine, University of Freiburg, Germany.
  • Staudacher DL; Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Germany; Department of Medicine III (Interdisciplinary Internal Medicine Intensive Care), Faculty of Medicine, University of Freiburg, Germany.
  • Zotzmann V; Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Germany; Department of Medicine III (Interdisciplinary Internal Medicine Intensive Care), Faculty of Medicine, University of Freiburg, Germany. Electronic address: viviane.zotzman
Respir Med ; 172: 106135, 2020 10.
Article in English | MEDLINE | ID: covidwho-773282
Semantic information from SemMedBD (by NLM)
1. Pulmonary artery structure LOCATION_OF Thrombus
Subject
Pulmonary artery structure
Predicate
LOCATION_OF
Object
Thrombus
2. Thrombus CAUSES Respiratory Distress Syndrom
Subject
Thrombus
Predicate
CAUSES
Object
Respiratory Distress Syndrom
3. Pneumonia PROCESS_OF Patients
Subject
Pneumonia
Predicate
PROCESS_OF
Object
Patients
4. Segmental pulmonary artery LOCATION_OF Pulmonary Embolism
Subject
Segmental pulmonary artery
Predicate
LOCATION_OF
Object
Pulmonary Embolism
5. Pulmonary Embolism COMPLICATES Respiratory Failure
Subject
Pulmonary Embolism
Predicate
COMPLICATES
Object
Respiratory Failure
6. Parenchyma LOCATION_OF lung opacification
Subject
Parenchyma
Predicate
LOCATION_OF
Object
lung opacification
7. Lung LOCATION_OF Computed Tomography Angiography
Subject
Lung
Predicate
LOCATION_OF
Object
Computed Tomography Angiography
8. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
9. Thrombus AFFECTS Cohort
Subject
Thrombus
Predicate
AFFECTS
Object
Cohort
10. Thrombus PROCESS_OF Patients
Subject
Thrombus
Predicate
PROCESS_OF
Object
Patients
11. Segmental pulmonary artery LOCATION_OF Thrombus
Subject
Segmental pulmonary artery
Predicate
LOCATION_OF
Object
Thrombus
12. Thrombus COEXISTS_WITH COVID-19
Subject
Thrombus
Predicate
COEXISTS_WITH
Object
COVID-19
13. Pulmonary artery structure LOCATION_OF Thrombus
Subject
Pulmonary artery structure
Predicate
LOCATION_OF
Object
Thrombus
14. Thrombus CAUSES Respiratory Distress Syndrome, Adult
Subject
Thrombus
Predicate
CAUSES
Object
Respiratory Distress Syndrome, Adult
15. Pneumonia PROCESS_OF Patients
Subject
Pneumonia
Predicate
PROCESS_OF
Object
Patients
16. Segmental pulmonary artery LOCATION_OF Pulmonary Embolism
Subject
Segmental pulmonary artery
Predicate
LOCATION_OF
Object
Pulmonary Embolism
17. Pulmonary Embolism COMPLICATES Respiratory Failure
Subject
Pulmonary Embolism
Predicate
COMPLICATES
Object
Respiratory Failure
18. Parenchyma LOCATION_OF lung opacification
Subject
Parenchyma
Predicate
LOCATION_OF
Object
lung opacification
19. Lung LOCATION_OF Computed Tomography Angiography
Subject
Lung
Predicate
LOCATION_OF
Object
Computed Tomography Angiography
20. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
21. Thrombus AFFECTS Cohort
Subject
Thrombus
Predicate
AFFECTS
Object
Cohort
22. Thrombus PROCESS_OF Patients
Subject
Thrombus
Predicate
PROCESS_OF
Object
Patients
23. Segmental pulmonary artery LOCATION_OF Thrombus
Subject
Segmental pulmonary artery
Predicate
LOCATION_OF
Object
Thrombus
24. Thrombus COEXISTS_WITH COVID-19
Subject
Thrombus
Predicate
COEXISTS_WITH
Object
COVID-19
ABSTRACT

PURPOSE:

Patients hospitalized for infection with SARS-CoV-2 typically present with pneumonia. The respiratory failure is frequently complicated by pulmonary embolism in segmental pulmonary arteries. The distribution of pulmonary embolism in regard to lung parenchymal opacifications has not been investigated yet.

METHODS:

All patients with COVID-19 treated at a medical intensive care unit between March 8th and April 15th, 2020 undergoing computed tomography pulmonary angiography (CTPA) were included. All CTPA were assessed by two radiologists independently in respect to parenchymal changes and pulmonary embolism on a lung segment basis.

RESULTS:

Out of 22 patients with severe COVID-19 treated within the observed time period, 16 (age 60.4 ± 10.2 years, 6 female SAPS2 score 49.2 ± 13.9) underwent CT. A total of 288 lung segment were analyzed. Thrombi were detectable in 9/16 (56.3%) patients, with 4.4 ± 2.9 segments occluded per patient and 40/288 (13.9%) segments affected in the whole cohort. Patients with thrombi had significantly worse segmental opacifications in CT (p < 0.05) and all thrombi were located in opacitated segments. There was no correlation between d-dimer level and number of occluded segmental arteries.

CONCLUSIONS:

Thrombi in segmental pulmonary arteries are common in COVID-19 and are located in opacitated lung segments. This might suggest local clot formation.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Pulmonary Artery / Pulmonary Embolism / Respiratory Distress Syndrome / Thrombosis / Coronavirus Infections / Pandemics / Computed Tomography Angiography / Lung Type of study: Diagnostic study / Etiology study / Observational study Limits: Female / Humans / Male / Middle aged Language: English Journal: Respir Med Year: 2020 Document Type: Article Affiliation country: J.rmed.2020.106135

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Pulmonary Artery / Pulmonary Embolism / Respiratory Distress Syndrome / Thrombosis / Coronavirus Infections / Pandemics / Computed Tomography Angiography / Lung Type of study: Diagnostic study / Etiology study / Observational study Limits: Female / Humans / Male / Middle aged Language: English Journal: Respir Med Year: 2020 Document Type: Article Affiliation country: J.rmed.2020.106135