Acute Pulmonary Embolism in COVID-19: A Potential Connection between Venous Congestion and Thrombus Distribution
Background: Vascular abnormalities, including venous congestion (VC) and pulmonary embolism (PE), have been recognized as frequent COVID-19 imaging patterns and proposed as severity markers. However, the underlying pathophysiological mechanisms remain unclear. In this study, we aimed to characterize...
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MDPI AG
2022-06-01
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| Online Access: | https://www.mdpi.com/2227-9059/10/6/1300 |
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| author | Franck Nevesny David C. Rotzinger Alexander W. Sauter Laura I. Loebelenz Lena Schmuelling Hatem Alkadhi Lukas Ebner Andreas Christe Alexandra Platon Pierre-Alexandre Poletti Salah D. Qanadli |
| author_facet | Franck Nevesny David C. Rotzinger Alexander W. Sauter Laura I. Loebelenz Lena Schmuelling Hatem Alkadhi Lukas Ebner Andreas Christe Alexandra Platon Pierre-Alexandre Poletti Salah D. Qanadli |
| author_sort | Franck Nevesny |
| collection | DOAJ |
| description | Background: Vascular abnormalities, including venous congestion (VC) and pulmonary embolism (PE), have been recognized as frequent COVID-19 imaging patterns and proposed as severity markers. However, the underlying pathophysiological mechanisms remain unclear. In this study, we aimed to characterize the relationship between VC, PE distribution, and alveolar opacities (AO). Methods: This multicenter observational registry (clinicaltrials.gov identifier NCT04824313) included 268 patients diagnosed with SARS-CoV-2 infection and subjected to contrast-enhanced CT between March and June 2020. Acute PE was diagnosed in 61 (22.8%) patients, including 17 females (27.9%), at a mean age of 61.7 ± 14.2 years. Demographic, laboratory, and outcome data were retrieved. We analyzed CT images at the segmental level regarding VC (qualitatively and quantitatively [diameter]), AO (semi-quantitatively as absent, <50%, or >50% involvement), clot location, and distribution related to VC and AO. Segments with vs. without PE were compared. Results: Out of 411 emboli, 82 (20%) were lobar or more proximal and 329 (80%) were segmental or subsegmental. Venous diameters were significantly higher in segments with AO (<i>p</i> = 0.031), unlike arteries (<i>p</i> = 0.138). At the segmental level, 77% of emboli were associated with VC. Overall, PE occurred in 28.2% of segments with AO vs. 21.8% without (<i>p</i> = 0.047). In the absence of VC, however, AO did not affect PE rates (<i>p</i> = 0.94). Conclusions: Vascular changes predominantly affected veins, and most PEs were located in segments with VC. In the absence of VC, AOs were not associated with the PE rate. VC might result from increased flow supported by the hypothesis of pulmonary arteriovenous anastomosis dysregulation as a relevant contributing factor. |
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| issn | 2227-9059 |
| language | English |
| last_indexed | 2024-03-10T00:20:31Z |
| publishDate | 2022-06-01 |
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| spelling | doaj.art-1a8ba865d18f4b42be476183c0a719092023-11-23T15:42:23ZengMDPI AGBiomedicines2227-90592022-06-01106130010.3390/biomedicines10061300Acute Pulmonary Embolism in COVID-19: A Potential Connection between Venous Congestion and Thrombus DistributionFranck Nevesny0David C. Rotzinger1Alexander W. Sauter2Laura I. Loebelenz3Lena Schmuelling4Hatem Alkadhi5Lukas Ebner6Andreas Christe7Alexandra Platon8Pierre-Alexandre Poletti9Salah D. Qanadli10Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, 21079 Dijon, FranceCardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), 1011 Lausanne, SwitzerlandDepartment of Radiology, University Hospital Basel, University of Basel, 4031 Basel, SwitzerlandDepartment of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, SwitzerlandDepartment of Radiology, University Hospital Basel, University of Basel, 4031 Basel, SwitzerlandInstitute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, 8006 Zurich, SwitzerlandDepartment of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, SwitzerlandDepartment of Radiology, Division City and County Hospitals, Inselgroup, Bern University Hospital, University of Bern, 3004 Bern, SwitzerlandService of Radiology Division of Clinical Epidemiology Service of Radiology, Geneva University Hospital, 1205 Geneva, SwitzerlandService of Radiology Division of Clinical Epidemiology Service of Radiology, Geneva University Hospital, 1205 Geneva, SwitzerlandCardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), 1011 Lausanne, SwitzerlandBackground: Vascular abnormalities, including venous congestion (VC) and pulmonary embolism (PE), have been recognized as frequent COVID-19 imaging patterns and proposed as severity markers. However, the underlying pathophysiological mechanisms remain unclear. In this study, we aimed to characterize the relationship between VC, PE distribution, and alveolar opacities (AO). Methods: This multicenter observational registry (clinicaltrials.gov identifier NCT04824313) included 268 patients diagnosed with SARS-CoV-2 infection and subjected to contrast-enhanced CT between March and June 2020. Acute PE was diagnosed in 61 (22.8%) patients, including 17 females (27.9%), at a mean age of 61.7 ± 14.2 years. Demographic, laboratory, and outcome data were retrieved. We analyzed CT images at the segmental level regarding VC (qualitatively and quantitatively [diameter]), AO (semi-quantitatively as absent, <50%, or >50% involvement), clot location, and distribution related to VC and AO. Segments with vs. without PE were compared. Results: Out of 411 emboli, 82 (20%) were lobar or more proximal and 329 (80%) were segmental or subsegmental. Venous diameters were significantly higher in segments with AO (<i>p</i> = 0.031), unlike arteries (<i>p</i> = 0.138). At the segmental level, 77% of emboli were associated with VC. Overall, PE occurred in 28.2% of segments with AO vs. 21.8% without (<i>p</i> = 0.047). In the absence of VC, however, AO did not affect PE rates (<i>p</i> = 0.94). Conclusions: Vascular changes predominantly affected veins, and most PEs were located in segments with VC. In the absence of VC, AOs were not associated with the PE rate. VC might result from increased flow supported by the hypothesis of pulmonary arteriovenous anastomosis dysregulation as a relevant contributing factor.https://www.mdpi.com/2227-9059/10/6/1300CTCT-angiographyinfectionlungpulmonary embolism |
| spellingShingle | Franck Nevesny David C. Rotzinger Alexander W. Sauter Laura I. Loebelenz Lena Schmuelling Hatem Alkadhi Lukas Ebner Andreas Christe Alexandra Platon Pierre-Alexandre Poletti Salah D. Qanadli Acute Pulmonary Embolism in COVID-19: A Potential Connection between Venous Congestion and Thrombus Distribution Biomedicines CT CT-angiography infection lung pulmonary embolism |
| title | Acute Pulmonary Embolism in COVID-19: A Potential Connection between Venous Congestion and Thrombus Distribution |
| title_full | Acute Pulmonary Embolism in COVID-19: A Potential Connection between Venous Congestion and Thrombus Distribution |
| title_fullStr | Acute Pulmonary Embolism in COVID-19: A Potential Connection between Venous Congestion and Thrombus Distribution |
| title_full_unstemmed | Acute Pulmonary Embolism in COVID-19: A Potential Connection between Venous Congestion and Thrombus Distribution |
| title_short | Acute Pulmonary Embolism in COVID-19: A Potential Connection between Venous Congestion and Thrombus Distribution |
| title_sort | acute pulmonary embolism in covid 19 a potential connection between venous congestion and thrombus distribution |
| topic | CT CT-angiography infection lung pulmonary embolism |
| url | https://www.mdpi.com/2227-9059/10/6/1300 |
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