Pulmonary Vascular Thrombosis in COVID-19 Pneumonia.
Pulmonary Vascular Thrombosis in COVID-19 Pneumonia.
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DOI：
10.1053/j.jvca.2021.01.011
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发表时间：
2021-12
影响因子：
2.8
通讯作者：
Zangrillo A
中科院分区：
文献类型：
--
作者：
De Cobelli F;Palumbo D;Ciceri F;Landoni G;Ruggeri A;Rovere-Querini P;D'Angelo A;Steidler S;Galli L;Poli A;Fominskiy E;Calabrò MG;Colombo S;Monti G;Nicoletti R;Esposito A;Conte C;Dagna L;Ambrosio A;Scarpellini P;Ripa M;Spessot M;Carlucci M;Montorfano M;Agricola E;Baccellieri D;Bosi E;Tresoldi M;Castagna A;Martino G;Zangrillo A
在严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）感染期间，已经假设发生了显著的内皮细胞损伤和肺微血管血栓形成。目的是评估肺血管血栓形成（PVT）是否是由于外周深静脉血栓形成的复发性血栓栓塞或局部炎症性内皮损伤，叠加血栓形成晚期并发症。观察性研究。教学医院的内科病房和重症监护病房。作者报告了一项前瞻性机构研究（CovidBiob研究）中纳入的临床疑似肺血管血栓栓塞的患者子集。计算机断层扫描肺血管造影以及实验室标志物和凝血特征的评价。55例患者中有28例（50.9%）显示PVT，症状发作的中位时间间隔为17.5天。22例患者同时发现多发性室性心动过速，16例双侧受累，主要累及肺段/亚段肺动脉分支（67.8%和96.4%）。与无PVT的患者相比，有PVT的患者毛玻璃样阴影面积明显更高（31.7% [22.9-41] vs17.8%[10.8-22.1]，p < 0.001）。值得注意的是，在所有28例患者中，毛玻璃样阴影面积和PVT几乎完全重叠。入院时的D-二聚体水平可预测PVT。研究结果确定了2019年冠状病毒病（COVID-19）肺炎的特定放射学模式，PVT的独特空间分布与磨玻璃影重叠。这些发现支持了COVID-19肺部炎症与PVT之间存在发病关系的假设，并挑战了先前与COVID-19肺炎相关的肺栓塞定义。计算机断层扫描肺血管造影（CTPA）成像显示，在三种不同的临床情况下，肺动脉分支中的最终充盈缺损（白色箭头）及其根据相应通气图的空间分布（白色箭头表示正常肺实质）。在（a）[非COVID-19肺炎]和（c）[非COVID-19 ARDS]中，在负责健康肺段血管化的肺动脉分支中选择性发现充盈缺损。相反，在（B）[COVID-19肺炎]中，充盈缺损分布和肺炎程度之间存在几乎完美的地形重叠。
During severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, dramatic endothelial cell damage with pulmonary microvascular thrombosis have been was hypothesized to occur. The aim was to assess whether pulmonary vascular thrombosis (PVT) is due to recurrent thromboembolism from peripheral deep vein thrombosis or to local inflammatory endothelial damage, with a superimposed thrombotic late complication. Observational study. Medical and intensive care unit wards of a teaching hospital. The authors report a subset of patients included in a prospective institutional study (CovidBiob study) with clinical suspicion of pulmonary vascular thromboembolism. Computed tomography pulmonary angiography and evaluation of laboratory markers and coagulation profile. Twenty-eight of 55 (50.9%) patients showed PVT, with a median time interval from symptom onset of 17.5 days. Simultaneous multiple PVTs were identified in 22 patients, with bilateral involvement in 16, mostly affecting segmental/subsegmental pulmonary artery branches (67.8% and 96.4%). Patients with PVT had significantly higher ground glass opacity areas (31.7% [22.9-41] v 17.8% [10.8-22.1], p < 0.001) compared with those without PVT. Remarkably, in all 28 patients, ground glass opacities areas and PVT had an almost perfect spatial overlap. D-dimer level at hospital admission was predictive of PVT. The findings identified a specific radiologic pattern of coronavirus disease 2019 (COVID-19) pneumonia with a unique spatial distribution of PVT overlapping areas of ground-glass opacities. These findings supported the hypothesis of a pathogenetic relationship between COVID-19 lung inflammation and PVT and challenged the previous definition of pulmonary embolism associated with COVID-19 pneumonia. Computed Tomography Pulmonary Angiography (CTPA) imaging demonstrating, in three different clinical scenarios, eventual filling defects in branches of the pulmonary arteries (white arrows) and their spatial distribution according to the corresponding ventilation maps (white asterisks indicate normal lung parenchyma). In (a) [non COVID-19 pneumonia] and (c) [non COVID-19 ARDS] filling defects are electively found in the branches of the pulmonary arteries accountable for the vascularization of healthy lung segments. On the contrary, in (b) [COVID-19 pneumonia] there is an almost perfect topographical overlap between filling defects distribution and pneumonia extent.
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DOI：
10.1148/ryct.2020200389
发表时间：
2020-10
期刊：
Radiology. Cardiothoracic imaging
影响因子：
--
作者：
Grodecki K;Lin A;Cadet S;McElhinney PA;Razipour A;Chan C;Pressman B;Julien P;Maurovich-Horvat P;Gaibazzi N;Thakur U;Mancini E;Agalbato C;Menè R;Parati G;Cernigliaro F;Nerlekar N;Torlasco C;Pontone G;Slomka PJ;Dey D
通讯作者：
Dey D
影响因子：
19.7
作者：
Caruso, Damiano;Zerunian, Marta;Laghi, Andrea
通讯作者：
Laghi, Andrea
影响因子：
5.4
作者：
Inciardi RM;Solomon SD;Ridker PM;Metra M
通讯作者：
Metra M
影响因子：
7.5
作者：
Klok, F. A.;Kruip, M. J. H. A.;Endeman, H.
通讯作者：
Endeman, H.
影响因子：
3.7
作者：
Cerdà P;Ribas J;Iriarte A;Mora-Luján JM;Torres R;Del Río B;Jofre HI;Ruiz Y;Huguet M;Fuset MP;Martínez-Yélamos S;Santos S;Llecha N;Corbella X;Riera-Mestre A
通讯作者：
Riera-Mestre A