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Pulmonary Vascular Thrombosis in COVID-19 Pneumonia. 2021
Francesco De Cobelli, and
Diego Palumbo, and
Fabio Ciceri, and
Giovanni Landoni, and
Annalisa Ruggeri, and
Patrizia Rovere-Querini, and
Armando D'Angelo, and
Stephanie Steidler, and
Laura Galli, and
Andrea Poli, and
Evgeny Fominskiy, and
Maria Grazia Calabrò, and
Sergio Colombo, and
Giacomo Monti, and
Roberto Nicoletti, and
Antonio Esposito, and
Caterina Conte, and
Lorenzo Dagna, and
Alberto Ambrosio, and
Paolo Scarpellini, and
Marco Ripa, and
Marzia Spessot, and
Michele Carlucci, and
Matteo Montorfano, and
Eustachio Agricola, and
Domenico Baccellieri, and
Emanuele Bosi, and
Moreno Tresoldi, and
Antonella Castagna, and
Gianvito Martino, and
Alberto Zangrillo
Vita-Salute San Raffaele University, Milan, Italy; Radiology Department, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.
OBJECTIVE 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. METHODS Observational study. METHODS Medical and intensive care unit wards of a teaching hospital. METHODS The authors report a subset of patients included in a prospective institutional study (CovidBiob study) with clinical suspicion of pulmonary vascular thromboembolism. METHODS Computed tomography pulmonary angiography and evaluation of laboratory markers and coagulation profile. RESULTS 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. CONCLUSIONS 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.
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